These documents are NHS England commissioning policies that apply to members of the Armed Forces and their families, where they are registered with a Defence Medical Services (DMS) practice in England, and for reservists whilst mobilised and registered for primary care services with a DMS practice in England.
These policies do not apply to members of the Armed Forces and their families registered with a DMS practice outside of England or to Armed Forces families who are registered with an NHS contracted GP practice or to reservists when not mobilised.
Integrated care boards (ICBs) are responsible for commissioning and delivery of health services for veterans and reservists (when not mobilised).
These policies also describe the eligibility criteria under which the NHS England Armed Forces Health Commissioning team will commission treatments or interventions classified as procedures and treatments that are of value, but only in the relevant clinical circumstances. Previously, they were referred to as procedures of low clinical priority. The policy has been updated following the Evidence Based Interventions (EBI) Programme.
These policies do not apply to those procedures required for members of the Armed Forces and mobilised reservists due to an occupational need in which circumstances the Ministry of Defence Case Assessment Panel (MODCAP) healthcare funding request process could be considered by the referrer.
Equality statement
Promoting equality and addressing health inequalities are at the heart of NHS England’s values. Throughout the development of the policies and processes cited in this document, we have:
- given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and
- given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities for the Armed Forces community (serving, reserves, veterans and families)
NHS commissioning and the Armed Forces Covenant
In its broadest sense the Armed Forces Covenant is a commitment from the nation that those who serve or have served, and their families, are treated fairly and not disadvantaged in their day-to-day lives because of their military service. It is supported by a wide range of organisations including the UK Government and Devolved Administrations, the NHS, local government, businesses. The Armed Forces Covenant is enshrined in law by the Armed Forces Act.
The NHS in its widest sense is required to uphold the key principles of the Armed Forces Covenant, which are:
- no member of the Armed Forces community should face disadvantage in the provision of public and commercial services compared to any other citizen
- in some circumstances special treatment may be appropriate especially for the injured or bereaved
The implication for NHS bodies is that they will be required to evidence / demonstrate they are giving ‘due regard’ to the health and social care needs of the Armed Forces community in the planning, commissioning and provision of healthcare services.
An important part of this is that the NHS England Armed Forces commissioning policies are embedded in NHS systems and enable commissioners and providers to deliver their statutory responsibilities and in doing so, pay due regard to the principles of the Armed Forces Covenant.
Policy implementation criteria
Patient safety
These policies apply to elective procedures only. Patients with an immediate clinical need should follow the appropriate clinical pathway to prevent harm and reduce risk.
Inclusion criteria
These policies apply to:
- serving members of the Armed Forces and their families, where they are registered with a DMS practice in England, and
- Reservists whilst mobilised and registered for primary care services with a DMS practice in England
Exclusion criteria
These policies do not apply to:
- members of the Armed Forces and their families registered with a DMS practice outside of England
- Armed Forces families who are registered with an NHS contracted GP practice
- reservists when not mobilised. ICBs are responsible for health services for reservists when they are not mobilised
- Veterans as ICBs are responsible for health services for veterans
These policies do not apply to those procedures required for members of the Armed Forces and mobilised Reservists due to an occupational need in which circumstances MODCAP healthcare funding request process could be considered by the referrer.
28 Day Faster Diagnosis Standard
This policy does not apply to patients with suspected malignancy who should continue to be referred under the 28 Day Faster Diagnosis Standard pathway rules for assessment and testing as appropriate.
Clinical parameters
Body Mass Index
Patients with an elevated BMI of 30 or more may experience more postsurgical complications including postsurgical wound infection so should be encouraged to lose weight prior to seeking surgery
Certain individuals with an elevated BMI may be a healthy weight for their build even though their BMI is classed as obese.
Other factors to consider when assessing BMI include athletic build, mobility, pregnancy and ethnicity.
See the NHS.uk website for further guidance.
Smoking
Surgical outcomes (for example wound healing, complications) can be adversely affected by smoking.
To ensure the best outcomes, patients should have stopped smoking prior to surgery. Smoking status may be validated at pre-operative appointment using an appropriate test. Support to stop smoking is available to patients.
Patients who are smokers should be referred to stop smoking services to reduce the risks of surgery and improve healing.
Governance arrangements
When prior approval is required
Where a patient requires treatment in secondary care for which prior approval is required, the referring healthcare professional should ensure the criteria is met. The secondary care healthcare professional who undertakes the consultation is generally required to make a prior approval application if applicable.
When prior approval is not required
Where a patient requires treatment in secondary care for which prior approval is not required, but treatment must be undertaken in line with the criteria, the referring healthcare professional should ensure the criteria is met but does not need to apply for prior approval before treatment can begin.
Individual Funding Request (IFR)
Where a consultant in secondary care receives a referral asking for a review and / or clinical opinion of a patient, if the consultant determines the patient requires treatment that does not meet criteria listed in the prior approval policy or is not a commissioned treatment, then an IFR could be considered: NHS England » Commissioning policy: Individual funding requests
Medical opinion
Where a healthcare professional wishes to refer to secondary care for a medical opinion only, then prior approval is not required.
Retrospective requests
NHS England Armed Forces Healthcare Commissioning team will not retrospectively fund any treatment undertaken for which prior approval was required.
Please note NHS England may audit providers against the criteria set out within this policy and any treatment provided outside of the policy criteria will not be funded.
Policy review
These policies will be reviewed when information is received which indicates that the policy requires revision or 2 years after publication.
These policies provide access to treatment on the basis that the prices will be at or below the prices and commercial terms submitted for consideration at the time evaluated.
NHS England reserves the right to review policies where the supplier of an intervention is no longer willing to supply the treatment to the NHS at or below this price and to review policies where the supplier is unable or unwilling to match price reductions in alternative treatments.
Generic references
- NHS England Commissioner assignment method 2025/26c
- Evidence Based Interventions (EBI) programme
- Getting It Right First Time (GIRFT) is a national programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change
- Health and Care Act 2022
- NHS England Commissioning policy: Individual funding requests
- Who Pays? sets out the framework for establishing which NHS commissioner will be responsible for commissioning and paying for an individual’s NHS care
- The Armed Forces Covenant is a promise by the nation ensuring that those who serve or who have served in the armed forces, and their families, are treated fairly
- The NHS.uk website
- The Royal College of Surgeons of England