Thinking of getting your aching varicose veins fixed? Or dealing with a large cyst on your eyelid? Or having an operation to release a trigger finger that won’t unfurl? Well, think again if you want it done on the NHS. These complaints that are often no longer funded.

Local clinical commissioning groups (CCGs) call the shots nowadays, deciding which of the procedures of limited clinical effectiveness (PoLCE) or procedures of limited clinical value (PoLCV) are available. There is no single list across the NHS; each CCG makes its own decisions about whom GPs can refer and what is and isn’t considered to be routine care. The rationale is that it’s wasteful and unjustifiable to fund treatments that don’t have a sound evidence base or are solely cosmetic. One stipulation, though, is that failing to fund the treatment must not cause significant harm to a person’s mental or physical health.

Your GP can fight your corner by filling out a special form. However, the criteria differ between CCGs and GPs may be reluctant. Searching your local CCG’s website for “PoLCE” will uncover the key document that spells out the specific criteria. For instance, if you live in Camden in north London and want to get your tonsils removed, you need “five or more episodes in the last year or four or more episodes in each of the last two successive years or three or more episodes in each of the last three years and ... significant impact on quality of life”.

The Royal College of Surgeons has complained that some of the procedures that are no longer available are actually essential and of proved clinical value. The growing list is “extremely detrimental to patients across the NHS, removing equality of access to treatment, creating postcode lotteries, lowering the standard of care provided in the NHS and potentially reducing the quality of life for some patients”. So, here are some suggestions of what you can do if an NHS referral is no longer available in your area.

Eyelid lumps, cysts and baggy eyelids

Consultant opthalmologist Jennifer Forbes says GPs should advise hot compresses and massage first and treat any acute infection with antibiotics. Most cysts get better without treatment within three months; if they persist, become very large or affect contact-lens wearers, NHS referral will usually be accepted. She says certain conditions, such as surgery for baggy eyelids, is rightly not funded on the NHS unless it is genuinely affecting vision. “The NHS should not be spending taxpayers money on ‘cosmetic’ procedures, so we are required to demonstrate a clinical need. In this case, we perform a visual field test to demonstrate if they have restricted vision before surgery is allowed.”

Varicose veins

You will be advised to try compression stockings, exercise (walking) and putting your feet up a few times a day for at least six months. NHS referral is usually funded only if the varicose veins cause such bad discomfort that you can’t stand at work or sleep at night, or lead to ulceration and bleeding. But consultant interventional radiologist Jocelyn Brooks says varicose veins are a sign of an underlying problem, chronic venous insufficiency (CVI), that results in the characteristic bulging veins, ulceration, pain and a buildup of pressure in the pelvis that may play a part in pelvic pain, heavy periods and period pain. “The point is that varicose veins are not just a cosmetic problem and that they can be fixed.”

Nice (the National Institute for Health and Care Excellence) guidelines recommend referral and treatment without needing to wait for serious, late complications. “The gold standard treatment is assessment by a specialist, ultrasound investigation (called a duplex scan) and then treatment called endovenous thermal ablation under local anaesthetic.” This minimally invasive technique uses laser or radio waves to cauterise (burn) the vein from the inside.

Skin lumps, bumps and spots

Moles, cysts, fat lumps (lipomas), skin tags (including anal ones), warts and blackheads are usually considered cosmetic problems; treatment is unlikely to be funded on the NHS. Moles are harmless, but it can be hard to be certain whether they are cancerous. NHS Choices has a useful visual guide, but see a GP if you are in doubt. You can get rid of small skin tags by tying dental floss tightly around the base or snipping them off with clean nail scissors. Your GP may offer to burn or freeze them off.

Heavy periods

Dilatation and curettage (D&C) to “scrape” the lining of the womb (uterus) used to be a common treatment for heavy periods. However, there was no evidence to support its use and it is rarely funded now. Better options are prescription-only drugs such as tranexamic acid, to reduce bleeding; hormones to stabilise the womb lining; the hormone-releasing Mirena coil, which can be inserted into the uterine cavity; and over-the-counter painkillers such as mefenamic acid.

Ganglia

These are fluid-filled smooth lumps near a joint, often on the back of wrists. While they are harmless, they can get as big as a golf ball. Surgical removal is no longer covered on the NHS in most areas unless the ganglia are painful or restrict movement or the diagnosis is uncertain. It is perfectly safe to wait; around half of all ganglia will get better without treatment. A brace or support can relieve the discomfort, but this should only be used for short periods to avoid muscle wasting. GPs with special training can drain the jelly-like contents, although half of ganglia will reform within a year.