Varicose vein referral

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This is a summary of the NHS Devon policy for varicose vein referral.

A recent audit in Western locality has revealed that varicose vein surgery is being performed on a significant number of Grade 2 varicose veins.

DRSS has been asked by NHS Devon and secondary care to tighten implementation of the current Varicose Veins Policy.

The majority of GP referrals will be unaffected, but there is going to be stricter implementation of the policy wording on "skin change".

It is considered that mild skin changes, for example haemosiderin deposition, thread veins and non varicose eczema are in keeping with Grade 2 veins and will therefore not be suitable for onward referral.

Recurrent thrombophlebitis, significant bleeding from varicosities, lipodermatosclerosis, varicose eczema and active or healed ulceration imply grade 3 or higher and can be referred into secondary care.

There will be a proforma (see referral section) for use by GP practices and further information on these changes in December's Planned Care News.

Supporting referral guidelines

Western: Varicose Vein clinical referral guideline

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Referral Criteria

Referral will not be routinely commissioned for patients with:

Grade 0: Thread/Flare/Reticular veins
Grade I: Varicose veins without symptoms
Grade II: Varicose veins with symptoms such as pain, aching, heaviness or swelling

NHS Devon will fund specialist advice and surgery if appropriate for the following:

Grade III: Varicose Veins with complications, including bleeding, recurrent phlebitis or eczema
Grade IV: Signs of venous insufficiency – lipodermatosclerosis or healed ulceration
Grade V: Active leg ulceration

Commissioning policy - Varicose Vein Referral

To receive exceptional funding, a clinical advocate for the patient needs to be able to demonstrate that:

the patient is significantly different to the general population of patients with the condition in question

and

the patient is likely to gain significantly more health benefit from the intervention that might be normally expected for patients with that condition.

Applications for consideration for funding approval should be sent to:

Email: d-icb.ifr-newsdt@nhs.net

Referral Forms

Varicose Vein Interventions referral form - No merge fields

Patient Information

Individual Funding Request (IFR)

Date of publication: January 2020

Referral