Nasal Surgery Septoplasty

Submit completed form via Individual Funding Request Team to

Rachel.anderson8@nhs.net or clarebrown4@nhs.net

Patient NHS Number : Name of GP :

Patient Name: Practice Code:

Date of Birth:

Address: GP Address:

Name of referring Surgeon: Hospital of referring Surgeon:

Does the patient smoke? Yes No If yes, have they been referred to smoking cessation?

Patients current BMI

All patients who are smokers should be referred by the GP to smoking cessation services at the initial referral.

Overweight patients are strongly encouraged to lose weight BEFORE their operation and should consider delaying
referral for non-urgent elective surgery; this is particularly applicable to patients who have a BMI over 40 or those with
a BMI between 30 and 40 who have metabolic syndrome-a combination of diabetes, high blood pressure and obesity.

Nasal surgery to improve cosmetic appearance of the nose, including Rhinoplasty and Septorhinoplasty, is
not routinely funded by MECCG

YES NO
Does the patient have a post traumatic nasal injury?

Does this cause continuous and chronic nasal airway obstruction

associated with septal/bony deviation of the nose which is causing
significant functional impairment?
Please provide details of functional impairment:

OR

YES NO
Nasal deformity secondary to a congenital craniofacial deformity
causing significant functional impairment (ie. Patient has a deviated
septum)
Please provide details of functional impairment:

OR

Is this part of reconstructive head and neck surgery?

Note: Cleft lip/palate patients are funded through NHS England commissioned Cleft Lip/Palate clinical management
pathway and not funded by MECCG.

MECCG will not approve funding for patients who are unhappy with the outcome of previous surgeries including
immediate post-trauma corrections (whether provided by the NHS or private providers) or for snoring unless they meet
the criteria above.

Funding for patients not meeting the above criteria will only be granted in clinically exceptional circumstances.

Applications for funding for these procedures can be made to the Exceptional Case Team but should only be made where
the patient demonstrates true clinical exceptionality.