Changes to NHS NEL Evidence Based Interventions (EBI) Policy

Please be aware of recent changes to the NHS North East London Evidence Based Interventions (EBI) policy relating to the management of individuals presenting with varicose veins. Reference should be given, in relation to the clinical management and onward referral into secondary care for this cohort of patients, to the advice and guidance outlined in the EBI policy.

For ease of reference the criteria are as follows:

Referral to a vascular service for assessment and treatment of varicose veins is not routinely funded by NEL ICB unless one of the following criteria are met and evidenced:

The below criteria apply to each leg individually.

With prior approval, NEL CCGs will fund treatment for varicose veins when one or more of the following criteria are met:

Intractable ulceration secondary to venous stasis

OR

Healed venous ulcerations in patients that cannot tolerate compression stockings for clinical reasons

OR

Significant haemorrhage from a ruptured superficial varicosity (serious enough to warrant transfusion or admission).

Commissioned providers may accept referrals and treat patients after a six-month trial of conservative management (comprising compression stockings AND exercise AND daily elevation several times a day) when varicosities result in either:

• Recurrent documented thrombophlebitis (two or more episodes)

OR

• Persistent skin changes (eczema, pigmentation, or lipodermatosclerosis) likely to result in venous ulceration.

Patients with persistent pain, aching, heaviness, itching, or swelling, should not be referred.

For patients whose veins are purely cosmetic and not associate with any symptoms do not refer for NHS treatment.

For further information please contact the NHS North East London Prior Approvals team: nelondonicb.hcdpas@nhs.net