Public funding and lipoedema

The NHS recognises lipoedema as being “a chronic (long-term) condition where there’s an abnormal build-up of fat cells in the legs, thighs and buttocks, and sometimes in the arms”. (https://www.nhs.uk/conditions/lipoedema/ accessed 23/11/17)

The NHS direct website has a section on lipoedema that describes tumescent liposuction as being the only effective treatment. There is also a statement to the effect that the NHS rarely funds liposuction but your GP can try to apply for funding via the CCG. Each CCG has different regulations as to what they will and won’t fund and many conditions are taken on a case by case basis. Evidence must be given to show that a patient’s condition is significantly worse that any other patient with the same condition. Invariably this is a hard thing to prove but a small number of sufferers have managed to secure public funding through their local Clinical Commissioning Group services. Where patients have been successful, the role of their GP has been essential.

Awareness of fat tissue disorders, including lipoedema, continues to make steady progress within primary care services. However, many GPs are not aware of the condition and failure to recognise lipoedema (which can often look like lymphoedema) is common. Many patients self-diagnose and often assist their GP in attaining a better understanding of the condition. From recent experience this is important because GPs remain the gatekeepers to most specialist medical services, including private surgical treatment. Without the GP’s support and willingness to submit an application then a patient is unlikely to secure NHS funding.

Patients are strongly encouraged to work with their GPs from the outset. If a patient has access to a lymphoedema nurse then their input can also be invaluable in supporting the application. Armed with this knowledge, GPs can explain fully the impact of lipoedema to a CCG who can assess the longer-term consequences if a recommended type of treatment is not supported by the NHS.

CCGs need to manage tight budgets and invariably each application for funding support will be on an individual basis. It is almost certain that CCG support will be for functional benefit only and not cosmetic benefit. For example, it is very unlikely that procedures to remove loose skin will be publicly funded.

After I have consulted with a patient, I will write a letter covering the history, symptoms and examination. I will then recommend a surgical treatment plan, which often requires multiple procedures. You can elect to share this information with your GP which can form the basis of an expert opinion and be used in support for any CCG application. However, your GP (sometimes in collaboration with local lymphoedema services) may also wish to consider other treatment options before supporting an application for surgery.

CCG applications need to come from a patient’s GP although on request I will gladly offer clinical information to a GP to support their patient’s CCG application. It is always preferable to wait for a final CCG decision (including all appeals) before considering self-funding arrangements if unsuccessful.

In summary, the CCG will consider funding for lipoedema on a case by case basis, but only if the patient is supported by their GP. It is the GP who will submit the application often with input from several health care professionals to support them. For more information on this matter or lipoedema in general, please visit Lipoedema UK.

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