Many patients weighing up varicose vein treatment find themselves comparing two very different options: pursuing treatment on the NHS or going privately. I am sometimes asked in consultations about the benefits of private treatment over the NHS route, and it is an entirely sensible thing to want to understand before making a decision.
The honest answer is that both routes have their place, but they offer very different experiences. Eligibility, waiting times, treatment methods, and the overall journey can vary considerably depending on which path you take.
Can you get varicose vein treatment on the NHS?
In short, yes, but only if you meet specific clinical criteria.
Over the last fifteen years or so, the NHS has progressively tightened access to varicose vein treatment. The NHS website states that treatment to improve how varicose veins look is not usually available if they are not causing any other problems. To qualify for funded treatment, you need to be experiencing one or more of the following:
- Significant pain, aching, or heaviness that affects your daily life
- Skin changes such as venous eczema or discolouration
- Bleeding from a varicose vein
- A healed or active leg ulcer below the knee
- A history of phlebitis (inflammation of the vein)
If your varicose veins are mainly a cosmetic concern, or if your symptoms are mild, the NHS will usually decline to treat you. This comes as a surprise to many patients, particularly those who are clearly suffering with aching, throbbing, or restless legs but do not yet have visible skin damage.
It is also worth noting that eligibility can vary by region. A 2023 study published in the British Journal of Surgery found that fewer than a third of NHS commissioning policies were fully compliant with national NICE guidance, which has led to what some patients describe as a postcode lottery.
What does the NHS pathway look like?
Assuming you are eligible, the NHS journey usually involves several stages:
- GP appointment. Your GP will assess your symptoms and decide whether to refer you to a vascular service.
- Specialist consultation. A vascular consultant will examine you and arrange a duplex ultrasound scan to assess blood flow.
- Treatment decision. If you meet the criteria, you will be offered a procedure based on local availability.
- This is performed at an NHS hospital or clinic.
- Follow-up. This may be carried out by your GP rather than the consultant.
The challenge for many patients is the time involved. The standard NHS referral-to-treatment target is eighteen weeks, but in reality, vascular surgery is often classified as low priority. Following the COVID-19 pandemic, the Vascular Society of Great Britain and Ireland classified varicose vein procedures as Priority 4, meaning treatment can routinely be delayed for more than three months. In practice, many patients wait considerably longer, sometimes a year or more, between referral and treatment.
What treatment will the NHS offer?
NICE Clinical Guideline 168 recommends a tiered approach:
- Endothermal ablation (laser or radiofrequency) is offered first
- If that is unsuitable, ultrasound-guided foam sclerotherapy is offered
- If foam sclerotherapy is unsuitable, surgery is offered
In practice, what you are offered locally depends on what your NHS trust has available. Some trusts still offer traditional ligation and stripping surgery, which involves a general anaesthetic, incisions in the groin and lower leg, and a recovery period of one to two weeks. The Circulation Foundation, the UK vascular disease charity, provides excellent patient information explaining what these procedures involve.
Patients often tell me they feel uncertain about which consultant will perform their procedure on the NHS. This is partly because, as several NHS trusts make clear in their patient literature, varicose vein surgery is often pooled, meaning you may be switched between consultants to maximise theatre use.
How is private treatment different?
Going privately removes the eligibility criteria and the waiting times. You do not need to demonstrate that your veins are causing skin damage or ulceration. If they are causing you discomfort, embarrassment, or simply concern, you are entitled to seek treatment.
At Southwest Veins, the patient journey is simple:
- You book a free initial assessment, either in person or via video consultation
- I personally examine your legs and discuss what is happening
- If treatment is appropriate, we agree a clear plan and a single all-inclusive price
- Treatment is carried out as a walk-in, walk-out procedure
- You are followed up at six weeks and again at six months
There is no need for a GP referral, no waiting list, and no uncertainty about who will be looking after you.
Why I favour foam sclerotherapy
Throughout my career, my ethos has been to keep things as simple as possible. Varicose veins are not a complex disease process. They are a structural problem caused by faulty valves in the superficial veins, and in my view, they deserve a straightforward solution.
That is why we use foam sclerotherapy at Southwest Veins. It involves injecting a specially prepared medical foam into the affected vein under ultrasound guidance. The foam irritates the lining of the vein, causing it to seal shut. Blood is then naturally redirected through healthier veins.
The benefits, compared with what most patients experience on the NHS, are considerable:
- No general anaesthetic. The procedure is performed under local conditions, with no need to be put to sleep.
- No incisions or stitches. Foam sclerotherapy is injection-based, so there is nothing to cut and nothing to heal in terms of surgical wounds.
- Walk-in, walk-out treatment. Most patients are in and out within around an hour.
- Minimal recovery time. Gentle walking is encouraged straight away, and most patients return to normal activities very quickly.
- No waiting lists. Treatment can usually be arranged within a matter of weeks.
- Continuity of care. I personally carry out the assessment, the treatment, and the follow-up appointments.
What about cost and value?
When patients compare private clinics, the pricing structure can sometimes feel confusing. Catheter-based techniques such as endovenous laser or radiofrequency ablation rely on expensive specialised equipment and disposable catheters, and the cost of these is reflected in the fees charged. It is also not uncommon for some clinics to charge separately for the treatment of smaller peripheral veins, which often need a separate sclerotherapy procedure alongside the catheter-based work.
At Southwest Veins, I have developed a simple pricing structure based around foam sclerotherapy. The package includes the treatment of both the main truncal vein and any associated branches, the follow-up appointments at six weeks and six months, and any further treatment that may be needed. Around five per cent of patients require a second short procedure to fully treat the truncal vein, and at Southwest Veins this is included in the original package price at no extra cost.
NHS or private: which is right for you?
There is no single right answer. The NHS provides excellent care, and for patients with severe complications such as ulceration or recurrent bleeding, NHS treatment is appropriate and free at the point of use. If you meet the criteria and are content to wait, that pathway is worth pursuing.
However, if any of the following apply, private treatment is often the more practical choice:
- Your symptoms do not yet meet the strict NHS thresholds, but they are affecting your quality of life
- You are not willing or able to wait many months for treatment
- You would like continuity of care with the same consultant from start to finish
- You prefer a minimally invasive treatment without general anaesthetic
- You value a clear, all-inclusive price with no hidden extras
In my experience, patients who choose private foam sclerotherapy often say afterwards that they wish they had done it sooner. Once the worry of waiting is removed and the treatment turns out to be far simpler than expected, the relief is considerable.
Book a free assessment
If you are weighing up your options and would like to discuss your varicose veins with a consultant vascular surgeon, I would be happy to see you for a free, no-obligation assessment. Appointments are available either in person at our Plymouth clinic or via video consultation, whichever suits you best.
Book your free assessment online now, or contact us with any questions you may have.
Jamie Barwell is a Consultant Vascular Surgeon who has treated over 1000 patients with varicose vein problems, using open surgical techniques and, since 2007, foam sclerotherapy. He is a graduate of Guy’s Hospital Medical School and a fellow of Royal College of Surgeons of England.