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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, CCGs and STPs, 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.


Final recommendations will then be made by the London Choosing Wisely Steering Group based on each of the clinical reviews. Final decisions will be made by London’s 32 CCGs.

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.

Healthy London Partnership is committed to continually improving the health of all Londoners on behalf of our partners. Contact the programme via

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