Changes to referrals for varicose veins  

FAO: PCNs in Tower Hamlets / Newham / Waltham Forest / Hackney

In order to prioritise patients with the most urgent clinical need, we are changing the referral criteria for secondary care treatment for varicose veins into Barts Health NHS Trust. This will support our vascular team in prioritising resources for complex work such as arterial diagnoses.  

It has been identified that a section of patients with pain and or discomfort as the sole symptom have poor outcomes from Patient Reported Outcome Measures (PROMs). Furthermore, there is little correlation between pain as a sole symptom and the objective severity of venous insufficiency on duplex ultrasound. Implementation of local anaesthetic endovenous solutions as per NICE guidance has the effect of worsening the PROMs further as cosmetic improvement is not always a primary result from total endovenous surgery. 

From July 25, we will no longer be accepting referrals or listing patients who have pain listed or identified as their only symptom. Over the next one to two months, we will also be contacting patients currently waiting that have yet to be seen, to let them know their referral will no longer be accepted. The revised criteria are included as an appendix. 

In conjunction with the changes in referral criteria, we have reviewed and aligned our eRS Directory of Service (DOS). A table summarising the new services on eRS is below. All referrals to the vascular service will be triaged via an Advice & Refer model and will be either accepted, returned with advice provided or rejected if they do not align with the new criteria. 

To support both GPs and patients with any questions in regard to their treatment options available, we are standing up a hotline that will be staffed by vascular clinical nurse specialists, and will be available from 2pm until 4.40pm on Tuesdays, Wednesdays and Thursdays for the next 3 weeks ending on 15 August 2025. The direct number for this service is 0203 594 2800. 

We understand these changes will impact patients and we will be providing the below advice to help them manage their symptoms, which may also be helpful for primary care colleagues. These changes have gone through governance processes at a trust and ICB level, including North East London Clinical Advisory Group (NEL CAG). 

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Advice for patients

Here are a few tips on how you can manage symptoms associated with varicose veins. 

• Compression Therapy: Wear compression stockings (graduated), and below the knee. They can help improve blood flow by applying pressure to the legs, which reduces venous pooling and swelling. Please ask your GP to prescribe these for you. You will need to have your leg measured at the pharmacy where you pick up your prescriptions. These stockings are best worn during the day, especially when standing or walking. They do not need to be worn when the legs are elevated – for example at night when in bed. Occasionally patients find a stocking that is longer (thigh length) is more comfortable for them.
• Leg Elevation: Elevate legs at least 2–3 times daily for 15–30 minutes. Helps blood flow back to the heart and reduces venous pressure. 
• Exercise Regularly: Low-impact exercises like walking, swimming, or cycling promote calf muscle contraction, which improves venous return. Aim for at least 30 minutes a day most days of the week. 
• Weight Management: Excess weight increases pressure on leg veins. Even modest weight loss can reduce symptoms. 
• Avoid prolonged periods of standing or sitting: If your job involves long periods of standing or sitting, take short walking breaks or flex your calf muscles every 30 minutes. Avoid crossing your legs when you sit. 
• Healthy Diet and Hydration:  High-fiber, low-salt diet reduces pressure on veins. This diet prevents constipation, which can exacerbate venous pressure. 
• Topical creams: These are not currently recommended for aching varicose veins except for a vein that has become hard and painful due to inflammation. This is called superficial thrombophlebitis. If this happens, please see your GP – they will prescribe Hirudoid cream and also refer you to vascular surgery for a further opinion. All patients with varicose veins should consider regular moisturising cream to use for the legs if they have dry skin. If your skin is worsening, despite that, please see your doctor who may refer you for a further opinion if you develop a skin rash because of your veins.