Audit of Breast Reduction Surgery Provision in England reveals Postcode Lottery

Criteria for funding Breast Reduction surgery laid down by the Primary Care Trusts (PCTs) in England vary widely. There was anecdotal evidence of a “postcode lottery” of provision of this intervention which has well-documented health benefits. We surveyed the funding criteria for BBR of all 303 Trusts in England and found that even with explicit guidelines, considerable variation in local funding criteria exists with resultant inequalities in provision. This work was presented by one of our trainees, Will Wraight, at the annual meeting of the British Association of Aesthetic Plastic Surgeons.

Face paralysis surgery 'miracle'

A woman who had a pioneering operation for facial paralysis at a West Sussex hospital has said the surgeon who carried it out was a "miracle man".

Vivvy Butler, from Surrey, said she felt normal again and was able to smile after the temporalis tendon transfer at the Queen Victoria Hospital.

"This operation gave me back my face, which is wonderful," she said.

Plastic surgeon Charles Nduka said he hoped the technique would become more widely available across the UK.

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Facial Paralysis

Facial Paralysis is a devastating condition that has physical, social, and psychological effects. Patients are typicaly referred from a variety of routes (e.g. GP, neurosurgeons, ENT, maxillofacial surgeon, ophthalmologist, or rehabilitation specialist). Often the referral pathway is dis-jointed with patients travelling to several different hospitals to receive the various elements of care. Also, little emphasis has been placed on the psychological impact of facial paralysis.

These issues led me to drive the development of a new Multidisciplinary Facial Palsy Clinic- the first of its kind in the UK. The facial palsy service includes specialist physiotherapy, speech & language therapy, psychological therapy, ophthalmology, as well as consultants in plastic, maxillofacial, and ophthalmic surgery.

Unique clinic proformas and information booklets were written to ensure quality assurance. Furthermore, objective and subjective assessments were integrated into the clinical documentation and treatment pathways to allow audit and research in the future. Our specialist physiotherapist performs facial EMGs on site which generates additional income for the Trust and makes the service financially viable.

The first quarterly clinic was held in April 2007 and due high demand, the number of clinics has been increased.

Development of improved access to lower limb trauma

Following my appointment in May 2006, a major objective was to help improve the management of lower limb trauma patients. These patients, many of whom are elderly often wait for weeks at their local hospitals before transfer to the QVH for surgery.

I took on the role of surgical lead for the newly convened Outliers’ Committee chaired by Tony Josling and including representatives from anaesthetics, admissions, the wards and management. The aim was to i) improve the triaging of referrals, ii) minimise inappropriate transfers of unfit patients, iii) shorten the referral to surgery time, and iv) expedite repatriation to the referring hospital.

I have re-drafted the Outlier Referral Form to capture as much relevant information as practical and thus aid triage. I have also instituted a system requiring that all referrals are discussed with me or a colleague with a lower limb trauma interest prior to formal acceptance. Finally, with the help of management, specified operating lists were identified for outliers to minimise cancelled operations.

A recent re-audit revealed shorter intervals from referral to admission and from admission to surgery, fewer cancelled operations, shorter hospital stay, and zero peri-operative deaths.

Further improvement by speedier repatriation to the local hospital is an area for further improvement.