The deleterious impact of primary care-based commissioning on plastic surgery services and patients.

The wide variation in the availability of treatments across the National Health Service (NHS) in England has led to a postcode lottery due to the rationing of available services by individual Primary Care Trusts (PCTs). In 2005 an NHS Modernisation Agency document, "Action on Plastic Surgery" was designed to aid PCTs making funding decisions on Plastic Surgery patients. Despite this and evidence in the Plastic Surgery literature, patients continue to experience difficulties in the primary care setting accessing our services.(3) The authors present two patients who presented to their GPs requesting to seen by the local Plastic Surgery service regarding their symptoms in an effort to explore the possible available treatment modalities. These patients were not referred and subsequently these patients operated upon themselves leading to complications which warranted inpatient management.