COSMETIC genital procedures, back massages and the removal of warts will not be funded on the NHS in Bolton, top health chiefs have decided.

Members of the Bolton Clinical Commissioning Group (CCG), which agrees the allocation of NHS funds in the borough, met on Friday to agree a framework for which treatments can be offered free of charge to patients.

They agreed that genital plastic surgery for women – a procedure called labiaplasty — will not be funded for cosmetic reasons.

It follows a reported rise of requests for the surgery as patients complain of a lack of body confidence.

However in the case where a woman’s private parts have been distorted due to a traumatic injury or disease doctors will be able to offer the treatment.

Members of the CCG also agreed that the NHS will not pay for the removal of skin lesions that are not cancerous — but if they suspected to be malignant, patients will be referred to cancer services for more investigations.

Treatment for persistent, non-specific lower back pain — including massages, lumbar supports, injections of therapeutic drugs and electrical nerve stimulation — will also not be offered.

GP Colin Mercer, who is the clinical director for clinical governance and safety, said it was now part of doctors’ jobs to communicate to patients what treatments are possible with limited funding.

He said: “We now have to advocate for the health services, and explain that we cannot do some services.

“It is about having those difficult conversations with patients, and I think we will get better at them.

“We need to help patients coming to general practice understand that the health service is in difficulties at the moment, to understand the bigger picture and put their needs behind someone else that is more important.

“It is about making it real for the population, and explaining that they are not being denied something but we are making our policy work for the population.”

The proposals are part of a strategy across Greater Manchester to make sure patients have fair and equal access to treatment, and are not dependent on a ‘postcode lottery’.

Su Long, chief officer of the CCG, said it was not about denying patients options.

“These are not suddenly, instinctive things that we are not doing”, she added.

“Our public are quite intelligent and quite aware – they understand that sometimes we have to make choices.

“It is now important that we keep talking to our patients, so that they understand what we are trying to do.”