What are complementary and alternative therapies?

Complementary and alternative medicines (CAMs) are treatments that fall outside of mainstream healthcare.

These medicines and treatments range from acupuncture and homeopathy, to aromatherapy, meditation and colonic irrigation. There is no universally agreed definition of CAMs. Although ‘complementary and alternative’ is often used as a single category, it can be useful to make a distinction between the two terms.

The US National Center for Complementary and Integrative Health (NCCIH) uses this distinction:

  • When a non-mainstream practice is used together with conventional medicine, it’s considered ‘complementary’
  • When a non-mainstream practice is used instead of conventional medicine, it’s considered ‘alternative’.

There can be overlap between these two categories. For example, aromatherapy may sometimes be used as a complementary treatment, and in other circumstances is used as an alternative treatment. A number of complementary and alternative treatments are typically used with the intention of treating and alternative treatments are typically used with the intention of treating or curing a health condition.

Treatment

CAMs are not routinely commissioned as stand-alone therapies or as complementary therapies and include, but not exclusively the following interventions found in this leaflet.

Not normally funded treatment or procedure

CAMs covers a wide range of therapies. An evidence review undertaken on behalf of Birmingham and Solihull CCG, showed a lack of clinical evidence to support the clinical effectiveness of a variety of complementary and alternative therapies.

The Birmingham and Solihull CCG decision is supported by the inclusion of Homeopathy and Herbal Treatments in the NHS England Guidance to CCGs on Items which should not be routinely prescribed in Primary Care. Therefore, CAMs are not routinely commissioned due to a lack of evidence to support clinical effectiveness.

Acupuncture falls outside of this clinical review and is covered under a separate policy: ‘Acupuncture for Indications Other than Back Pain’. This means (for patients who DO NOT meet the above criteria) the CCG will only fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and that is supported by the CCG.

Advice and further guidance

  • For more information, search for ‘complementary and alternative medicine’ at www.nhs.uk 
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

What are other cosmetic procedures?

Cosmetic surgery is often carried out to change the patient's appearance in order to achieve what they perceive to be a more desirable look.

Not normally funded treatment or procedure:

Cosmetic procedures are not routinely funded by the patient's local NHS commissioning organisation. The following procedures are not normally funded, all of which come under the Royal College of Surgeons ‘Categorisation of Cosmetic Surgery’:

Cosmetic breast surgery:

  • Cosmetic surgery of the nipple (inversion, retraction, or enlargement of the nipple, skin changes in and around the nipple)
  • Boob job or breast implant surgery (augmentation mammoplasty)
  • Breast surgery (autologous fat transfer to breast for symmetrisation / augmentation)
  • Breast surgery to even the size and shape of breasts (breast symmetrisation)
  • Male breast reduction (correction of gynaecomastia)
  • Breast lift for sagging or drooping breasts (mastopexy)
  • Breast reduction surgery (reduction mammoplasty).

Cosmetic nasal surgery:

  • Nose job or nose correction surgery (rhinoplasty).

Cosmetic surgery of the eyes and surrounding area:

  • Brow lift
  • Midface lift
  • Removal of loose folds of skin from the upper eyelids (upper lid blepharoplasty)
  • Removal of loose skin or ‘bags’ from lower eyelids (lower lid blepharoplasty).

Cosmetic surgery of the ear:

  • Ear pinning or ear correction surgery (otoplasty).

Cosmetic facial contouring surgery:

  • Bone implants (alloplastic augmentation) of the facial skeleton
  • Bone grafting of the facial skeleton
  • Free fat grafting to the face
  • Chin reduction or shaping surgery (genioplasty).

Cosmetic surgery of the face:

  • Cosmetic facial contouring
  • Brow lift
  • Cosmetic surgery or facial toning procedure used to give a more youthful facial appearance (rhytidectomy)
  • Neck muscles surgery to remove band lines on the neck (platysmaplasty).

Cosmetic surgery of the face/nose/ears:

  • Fat grafting/transfer (autologous fat transfer)
  • Correcting defects, deformities, and disfigurations of the eyelids (blepharoplasty)
  • Brow lift
  • Facelifts (rhytidectomy)
  • Facial contouring surgery
  • Midface lift
  • Ear repositioning (otoplasty)
  • Neck muscles surgery to remove band lines on the neck (platysmaplasty)
  • Reconstructive facial recontouring or remodelling
  • Nose job or nose correction surgery (rhinoplasty).

Cosmetic body contouring surgery:

  • Tummy tuck (abdominoplasty)
  • Cosmetic surgery of the hand
  • Autologous fat transfer
  • Body lift
  • Arm lift (brachioplasty)
  • Buttock lift (gluteal augmentation)
  • Calf reduction surgery (calf augmentation)
  • Liposuction
  • Thigh lift.

Massive weight loss surgery (mwl) - supplementary certificate in body contouring following massive weight loss:

  • Post bariatric surgery/Massive Weight Loss (MWL) tummy tuck (abdominoplasty)
  • Post bariatric surgery/MWL arm lift (brachioplasty)
  • Post bariatric surgery/MWL autologous fat transfer
  • Post bariatric surgery/MWL body lift
  • Post bariatric surgery/MWL liposuction
  • Post bariatric surgery/MWL thigh lift.

The clinician in charge of the care of the patient's specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

See separate leaflet for more information on Individual Funding Requests (IFRs).

Advice and further guidance:

The Care Quality Commission (CQC) website gives details of treatment centres that can perform the operation or treatment. All independent clinics and hospitals that provide cosmetic surgery in England must be registered with the CQC. The CQC publishes inspection reports and performance ratings to help people choose care.

  • For more information search for ‘cosmetic surgery’ at www.nhs.uk
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

What is revision of previous cosmetic surgery?

Revision plastic surgery encompasses any cosmetic or reconstructive surgical procedure that has to be repeated after a previous procedure. Revision may be performed for movement (functional) or looks (aesthetic) purposes.

Not normally funded treatment or procedure:

Revision surgery following previous cosmetic surgery is not normally funded by the patient’s local NHS commissioning organisation. This is because the financial risk of revision surgery lies with the organisation which provided the original treatment or procedure.

It is also important to note that revision of plastic surgery procedures originally performed in the private sector will not be funded. Referring clinicians should re-refer to the practitioner who carried out the original treatment.

The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

See separate leaflet for more information on Individual Funding Requests (IFRs).

Advice and further guidance:

  • For more information search for ‘guide to cosmetic surgeries’ at www.nhs.uk
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

 

What is a tummy tuck?

Tummy tucks (abdominoplasty or apronectomy) are surgical procedures performed to remove excess fat and skin from the mid and lower tummy (abdomen). Many patients develop loose abdominal skin after pregnancy or substantial weight loss, whether it be due to surgical or dietary weight loss.

Not normally funded treatment or procedure:

Tummy tucks (abdominoplasty or apronectomy) are not normally funded by the NHS. This is because the removal of surplus skin or fat on the body is considered to be a cosmetic procedure.

The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

See separate leaflet for more information on Individual Funding Requests (IFRs).

Advice and further guidance:

  • For more information search for ‘tummy tuck’ at www.nhs.uk
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.