Health and Justice and Armed Forces service specific policies

NHS England is responsible for commissioning hospital and community healthcare services for armed forces personnel and their families registered with Defence Medical Services (DMS) GP practices in England, as well as for adults held in prisons, immigration removal centres and other secure and detained settings in England.

Since 2013, NHS England has been following a set of policies when commissioning healthcare services for these patient groups.

14 of these commissioning policies were reviewed as part of a consultation launched in July 2018 by the NHS Evidence-Based Interventions Programme. These policies are set out in the below.

No criteria – Individual Funding Request needed

  • Snoring surgery
  • Dilatation and curettage (D&C) for heavy menstrual bleeding in women
  • Knee arthroscopy for patients with osteoarthritis
  • Injections for nonspecific low back pain without sciatica

Revised NHS England national criteria

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets for glue ear in children
  • Tonsillectomy for recurrent tonsillitis
  • Haemorrhoid surgery
  • Hysterectomy for heavy menstrual bleeding
  • Chalazia removal
  • Arthroscopic shoulder decompression for subacromial shoulder pain
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release
  • Ganglion excision
  • Trigger finger release
  • Varicose vein surgery

The consultation proposed treatment access criteria for adoption across England, with the aim of reducing the number of clinically ineffective interventions, improving outcomes for patients and maximising value for taxpayers.

The outcomes of this consultation were considered by the NHS England Board on 28 November 2018 with members agreeing statutory commissioning guidance for implementing the recommendations. As a result, the above procedures are now subject to national clinical commissioning criteria.

If you require funding agreement for any of these procedures or have any queries relating to the implementation of the national clinical criteria for the armed forces community, please email the Prior Approvals Team at

If you have any queries relating to the Health and Justice policies, please refer to the appropriate regional contact.

The following policies remain in use on an interim basis. These policies are only for those patients in secure and detained settings or for those who are registered with a Defence Medical Services medical centre. These policies will be subject to consultation at a later date.

Armed forces services specific policy

NHS England is responsible for commissioning assisted conception services for serving armed forces personnel.

Assisted conception

This policy aims to ensure that armed forces couples receive treatment in line with NICE clinical guidance and have the same access to NHS treatment wherever they live or receive their services in England.

All prior approval applications for the armed forces community made under the above policies are screened to ensure that patients do not suffer disadvantage in terms of access to treatment and relative to other citizens in the area in which they live.


This policy aims to ensure that male Armed Forces patients are able to access NHS vasectomy services wherever they live or receive their services in England.

Prior approval should be sought for any vasectomy procedures that require a general anaesthetic. Any queries and applications should be submitted to