Depending on what has caused your patient’s lymphoedema/chronic oedema and where your practice is based, getting a referral to a lymphoedema practitioner can be very difficult. If the swelling is related to a cancer diagnosis then it should be possible for you to access specialist NHS treatment for your patient. If the condition is unrelated to a cancer diagnosis then it can be more challenging to find an appropriate service to refer to. Some areas will have services attached to tissue viability teams, venous teams, hospices or cancer services. The LSN holds a comprehensive list of specialist lymphoedema services in the UK; please email or telephone the LSN office to find your nearest service, specifying whether your patient has cancer or non-cancer related lymphoedema.

If you have decided to refer your patient to a specialist but there is no local service, it may be worth considering an out-of-area referral utilising the ‘choose and book’ service as some services are now available through this route.

If you are unable to access specialist care through any of the routes above, the following may assist you:

• Initiate basic treatment as described in ‘What can I do for my patient?’ section.
• In the presence of leaking legs or wounds, contact your local wound Clinical Nurse Specialist or tissue viability team to address the wound and reduce the risk of infection.
• Advise your patient to contact the LSN to ask for an advocacy pack – this pack contains information about how to navigate the NHS and seek care.
• You may like to consider applying for an individual funding request in line with your CCG policy if there is a therapist or clinic able to provide this service in your area outside of the NHS provision.
• Depending on your CCG arrangement it may be possible for you to access an individual health budget for your patient in order for them, with your support, to access their own treatment.
• You are in an ideal position to raise concerns about the lack of appropriate care for your patient with the CCG. If you would like to discuss setting up a service in your locality or raising a concern about the lack of service then contact the LSN for advice.