London Choosing Wisely

The London Choosing Wisely programme is a clinically-led review of evidence for a set of surgical procedures. It looks to ensure they are used consistently across London and their use follows a criteria that ultimately improves the health of patients.

Aim of the review

To make sure people with an equal need, wherever they live in London, have equal access to treatments. A standard approach across London means people will achieve better healthcare and doctors will have better guidance on what should be offered to patients.

Procedures that are being reviewed

Eight procedures will be reviewed by primary and secondary care clinicians, patient representatives, equality and diversity leads and public health experts:

  • Surgical removal of benign skin lesions (abnormal growth or abnormal appearance of skin)
  • Hip arthroplasty (replacement)
  • Knee arthroplasty (replacement)
  • Knee arthroscopy (keyhole surgery)
  • Interventional treatments for back pain
  • Varicose vein procedures
  • Shoulder decompression (removing bone spurs and soft tissue through keyhole surgery)
  • Cataract surgery (replacing a clouded eye lens with an artificial lens)

Partners involved

We will engage with clinicians across the NHS in London, Clinical Commissioning Groups (CCG) and Sustainability and Transformation Partnerships (STP), patient representatives and professional associations, among others, around the evidence we are reviewing and the proposals that arise from these reviews.

We will build on CCG policies and incorporate any work being carried out locally. The development of a London policy for each treatment will reduce variation of care for all Londoners by ensuring a consistent approach to implementing NICE guidance.

Sense checking phase

As part of the development of each draft policy a ‘sense checking’ phase has been introduced to ensure that the draft policy is easy to follow and use, and ensure patients receive the most effective clinically appropriate treatment available to them.

Please note that this is not a consultation but an additional phase of the programme particularly seeking comments from key stakeholders on how easy each draft policy is to follow and the clarity of the language used. London Choosing Wisely is advisory and the statutory duty for approval of London-wide policies rests with each CCG governing body who will have the opportunity to further review, engage and consult in line with local governance processes, before making a decision on implementation.

Feedback for the following draft policies has now closed:

  • Draft policy for procedures and interventions for benign skin lesions (closed: 9am Thursday, 24 May 2018).
  • Draft policy for primary hip arthroplasty (replacement) (closed: 5pm Monday, 4 June 2018).
  • Draft policy for knee arthroplasty (replacement) (closed: 5pm Monday, 4 June 2018).
  • Draft policy for interventional treatments for back pain (closed: 5pm Tuesday 19 June 2018).
  • Draft policy for treatment of subacromial shoulder pain (closed: 5pm Tuesday 19 June 2018).
  • Draft policy for cataract surgery (closed: 9am Monday, 10 September 2018).
  • Draft policy for knee arthroscopy (closed: 9am Monday, 10 September 2018).
  • Draft policy for varicose veins (closed: 9am Monday, 10 September 2018).


The London Choosing Wisely programme itself is advisory and the statutory duty for approval of London-wide policies rests with each CCG governing body who will have the opportunity to consult and debate the draft policies further, before making a decision. It will be for CCGs to further engage and / or consult locally, prior to implementation.

A message from Dr Vin Diwakar, Regional Medical Director for NHS England (London)

“I am pleased to play this part in this important programme that will put in place consistent pan London policies for these selected procedures. My role, as Chair of the London Choosing Wisely Steering Group, is to ensure that the process to develop pan London policies is robust and based on the best available evidence. This review process will include extensive analysis of current procedures and published research on clinically effective treatments, including NICE guidance. It will be led by primary and secondary care clinicians from across London, with critical input from public health experts, equality and diversity experts and patient representatives. As pan London policies are developed, I will work with Steering Group members, including clinical leads from across London, to ensure the rigour of this review. Once we are satisfied, policies will be presented to Clinical Commissioning Group Governing Bodies for decision.

“I am confident that this robust process, under clinical leadership throughout, will ensure we arrive at the best policies to improve healthcare by ensuring equality of access across London to all who require treatment for these conditions.”

More information

For more information about the London Choosing Wisely programme, please see its latest update and frequently asked questions in our resources section.

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