NHS England are 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 have been following a set of policies when commissioning healthcare services for these patient groups. Funding for these patients should not be sought through local ICBs or CSUs.

Prior approval should be sought from the NHS England Armed Forces healthcare team for the below conditions for all patients registered with a DMS practice. All Armed Forces health queries and applications should be submitted to the team at england.armedforcespriorapprovals@nhs.net.

A: Academy of Medical Royal Colleges (AOMRC) Evidence Based Interventions programme (national clinical commissioning 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 interventions

B: NHS England and NHS Improvement Armed Forces Health national clinical commissioning criteria

• N-SC004 Breast Implant removal and reinsertion
• N-SC004 Breast Implant removal and reinsertion application form
• N-SC023 Labiaplasty, Vaginoplasty and Hymenorrhaphy
• N-SC023 Labiaplasty, Vaginoplasty and Hymenorrhaphy application form
• N-SC024 Laser surgery for short sight
• N-SC024 Laser surgery for short sight application form
• N-SC025 Mirena Coils in secondary care
• N-SC025 Mirena Coils in secondary care application form
• N-SC027 Pinnaplasty/Otoplasty
• N-SC027 Pinnaplasty/Otoplasty application form
• N-SC032 Tattoo Removal
• N-SC032 Tattoo Removal application form

Assisted conception

NHS England and NHS Improvement are responsible for commissioning assisted conception services for serving armed forces personnel. 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.

• N-SC037 Assisted Conception
• N-SC037 Assisted Conception application form

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.

Vasectomy

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.

• Interim Clinical Commissioning Policy – Vasectomy

Criteria based access

The following conditions do not require prior approval and the patient’s clinician can proceed with treatment if the criteria in the relevant policy are met:-

• N-SC001 Abdominal Wall Hernia Management and Repair in Adults
• N-SC007 Bunion Surgery
• N-SC008 Caesarean Section
• N-SC010 Circumcision
• N-SC011 Cosmetic surgery/treatment
• N-SC013 Laparoscopic Cholecystectomy for Asymptomatic Gall Stones
• N-SC015 Grommets (Children and Adults)
• N-SC017 Hair Removal (including Electrolysis and Laser Therapy)
• N-SC018 Hip impingement syndrome
• N-SC019 Hip resurfacing
• N-SC021 Knee Replacement surgery
• N-SC022 Knee washout and debridement
• N-SC026 Orthognathic Surgery
• N-SC028 Reversal of Vasectomy or Female Sterilisation
• N-SC031 Spinal surgery
• N-SC036 Removal of Third Molar teeth (Wisdom Teeth)

C: Any treatment, not listed above, which requires prior approval locally

D: Any high cost drug which requires prior approval locally