NHS GP referal to private clinic??

[warrenjames38]

So I went to my university GP last week to consult with her about my gyne. I was not expecting much because of my prior experience with my gp in my hometown were I was told they "could do nothing" for me and that "there are  patients with worse conditions in waiting lists for surgery". Basically, I was made to feel bad for even consulting them about something that is the cause of so much pain and other stress-related health issues (ironically diagnosed by the same doctor) in my life.

In the doctor's office I wasn't even comfortable with spelling out what I wanted to talk to her about - I'd use vague descriptions like "enlarged chest area" hoping she'd get the hint and say gyne first. She could tell just how uncomfortable I was when it came to examining me. After the examination she told me I did indeed have gynecomastia. She then asked me what I hope could be done for me. At this point I was thinking I was about to get a lecture about how my problem compares to other people's medical problems.I told her my life can't move forward with this and I am that desperate for anything even if it was not surgery. To my utter surprise (only seconds after examination) she asked if I would want her to refer me for surgery and I instinctively blurted out a yes before I could fully digest her question. I remember her saying because I am not overweight and in good shape;she is confident I do not need to lose weight and that surgery should be the next stage.

My disbelief at the kindness,understanding,and sensitivity I was experiencing about this issue from a GP, and the possibility of finally embarking on a journey that sets me free from this burden we all share, blurred everything she said thereafter.Now, I think there's a chance I may be wrong but I seem to remember her saying she would refer me to a private clinic and I would have to book an appointment with them the following week. She did say the funding would have to be subject to approval by the local trust, but she seemed to suggest I would get it.

I guess my question is does the NHS do private clinic referrals and if anyone has had a similar experience?

[ha032742]

Clinical Commissioning Groups (CCGs), which are made up of GP practices within a certain geographical area, control the budget for local healthcare services and are overseen by NHS England. Certain treatments/services are restricted due to cost implications and funding for these are only approved by the CCG if the patients meets very strict criteria. Usually surgery for cosmetic reasons, which gynaecomastia surgery rightly or wrongly falls under, is a restricted service but the actual criteria for funding varies from one CCG to another. CCGs can "outsource" some healthcare services to a private provider (e.g. a private hospital or a big healthcare company, like Virgin) as it may be more cost effective. It's likely that your local CCG has a contract with a private provider for general surgery/breast services only, which may mean the surgeons have limited experience of performing gynaecomastia surgery.

Even if the surgeon feels you would be a suitable candidate for surgery when you go to the private clinic, the CCG will have to approve funding. The likelihood of the funding request being successful/approved is entirely down to whether your case meets your local CCG's criteria for gynaecomastia surgery. For example, my local CCG has the following criteria:

The clinician should ensure that the following are confirmed:
- Breast cancer has been ruled out
- Testicular cancer has been ruled out
- Underlying endocrine or liver abnormality has been ruled out
- The condition is not due to the abuse of drugs with bodybuilding
- The condition is not a side effect of medication or drugs e.g. spironolactone,
cimedtidine, digoxin or cannabis.

Surgery to correct unilateral or bilateral gynaecomastia should be allowed if the patient:
- Is post pubertal (stable height for past 6 months) AND
- Has BMI < 25 kg/m2 with evidence that the patient’s weight has been stable for 2
years AND
- Has breast enlargement on at least one side which is Grade III or above using Cordova’s classification system OR has unilateral breast enlargement with a difference of at least 2 grades (e.g. normal and Grade II differential).

Scarring, contour irregularities and moderate asymmetry (including dog-ears, nipple direction or position, breast size and shape disparity) are predictable following surgery. Any post-surgical cosmetic irregularities will not be funded by the CCG in revision surgery.

Applications must include at least 2 colour photographs of the chest. Photographs should go from the top of the chest down to the umbilicus. One should be taken from directly in front of the patient and another at an angle of 45 degrees.

Hope my post has been useful and at least partially answered your question.

[warrenjames38]

Thank you so much for your reply, you have given me a lot of food for thought.
I think I should pass the long check list but I fear it's going to be a long process and I will be so pocked and prodded by the end of it 

When you said surgeons had  limited experience dealing with gyne, did you mean the NHS ones or Virgin?
Also did you end up getting the surgery or are you still in the process?

Again, thank you for your in-depth reply.

[ha032742]

Although male chest reduction surgery is becoming more common in the UK, it only accounts for a extremely small percentage of cosmetic surgery procedures performed annually therefore apart from a few like Dr. Karidis and Mr Levick (who both practice privately), the majority of plastic surgeons may only perform it a handful of times per year. General/breast surgeons (distinct from plastic surgeons) typically see it even less frequently as it's not their "bread and butter".  I suspect that your has GP has referred you to a general/breast surgeon albeit one based at a private hospital rather than a plastic surgeon.

I had surgery with Dr. Karidis last year and am happy with the result.

[warrenjames38]

Having researched the private clinics connected to my CCG; the surgeons appear to have a lot of  primary experience in breast reconstruction - especially for breast cancer patients whilst also specializing in gyne. I am going to go through this route first and cling on to the confidence my GP had in the process she immediately put me through without hesitation.

[ha032742]

That's reassuring if the breast surgeon has experience of gynaecomastia surgery. Good luck with the funding request!

[jdb]

I was seen by an NHS surgeon who was checking me for breast cancer which I turned out not to have. She immediately offered me surgery without me even asking.  She said she was an oncoplastic surgeon, qualified in both ordinary surgery and plastic surgery.  She explained that she had considerable experience of removing breasts from women with breast cancer and my breasts were no different to her.  As it happened I turned down her offer, being in my sixties I feared the surgery more than having breasts (I also have a heart condition).  She made it clear that it was the size of my breasts that convinced her I would be eligible for funding, I do not know what grade III is but I am about a 38D or DD.

[warrenjames38]

It's good that the option was put to you.It truly is a mixed picture when it comes to how the NHS approaches this matter; from the insensitive dismissive doctors to those who need you to say a few words and handle it with tact and sensitivity.