Wigs and the NHS

HeadzUp - For young people with alopecia

Wigs and the NHS

Who can get a wig on the NHS?

The National Health Service (NHS) makes provision for the supply of wigs to patients who need them. In order to qualify you need to have a referral from the dermatology department of your local hospital. If you have not been referred to your local dermatologist you need to speak to your GP and ask them to refer you. If you have alopecia that you are unable to cover up easily then you should qualify for a wig on the NHS.

How do I get a prescription?

It is up to your dermatologist to decide if you qualify for an NHS prescription for a wig. If considered suitable you will be given a prescription and a list of local NHS wig suppliers.

How much will I have to pay?

Prescription charges for NHS wigs are reviewed every April 1st . Currently (2006-2007) the charges are as follows in England:

Human hair custom made wigs: £212.85
Human hair partial wigs: £145.55
Stock size modacrylic wigs £55.10

Please note that the charge for a stock size modacrylic in Scotland is now £6.65 and patients aged 60 years or over are exempt. People living in Wales please check locally.

There are many exemptions to paying prescription charges – the hospital will advise you and don’t be too shy to ask! Over 60s in England are not exempt from the charge based on age alone however. If there is difficulty in paying you should complete form WF1 obtainable from your hospital Surgical Appliance Officer and help can often be received.

Where can I get my wig?

Your hospital will advise you of local suppliers of wigs who are able to accept NHS prescriptions. In order to be able to accept NHS prescriptions the wig company needs to sign a contract with the NHS. Wig suppliers under contract to the NHS must supply a very good standard of wig, a good choice and a confidential and quality service. For more information on the contract wig suppliers have with the NHS have a look at http://www.pasa.nhs.uk/orthotics/wigs/. Click on the contract specifications. Here you will find out more information on the agreed longevity period for wigs and how long you should be expected to wait for different wigs, repairs and cleaning.

The majority of suppliers, around twenty companies out of thirty or so, are members of the Hairdressing and Beauty Suppliers’ Association and have subscribed to a code of conduct as well as having to be registered to British Standards BS ISO 9001 and had their wig fitters checked by the Criminal Records Bureau to be “fit to deal with children and vulnerable adults.”

What wigs are available on the NHS?

Human hair wigs

These come in two types of hair, European hair and processed hair. Processed hair is hair, derived from China or India, which has been refined and the outside scaly layer, the “cuticle,” removed which stops it from tangling. It is then heavily colour treated affording a wide variety of shades from blonde to black. It is less expensive than European hair.

All hair fades over time. European hair wigs can, if recommended, be professionally dry-cleaned monthly by your supplier, paid for by the NHS. Processed hair wigs can normally be shampooed at home and must be carefully conditioned, as the hair has been dyed. Repairs to both types are paid for by the prescribing hospital. Custom made wigs, sometimes called “bespoke” wigs are expected to last three years when supplied in pairs.

European human hair wigs are always made to measure. Fewer are being prescribed as their cost increases.

Processed Hair wigs can be made to measure on a net base, with or without a monofilament nylon top and the hair can even be up to 45cm (18 inches) or longer, matched closely to your hair colour. Alternatively custom made processed hair wigs made on a moulded nylon and polyurethane base formed from a cast of the scalp are being prescribed by a limited number of hospitals. These have two trade names, Omega and Dermalite. This type of base is near transparent. The hair is knotted to the base very finely so that when parted it resembles a normal scalp.
There are also ready-to-wear processed real hair wigs, some on nylon monofilament top bases. The range is small and their lifespan is limited but they may find a place in certain circumstances e.g. for speed of supply.

Every type of wig and base can be made in a partial form when a full wig is not necessary. There’s a deal of skill required to measure and fit partial hairpieces successfully and many companies would prefer you to go to their head office for this specialised attention, when a cast or template is called for.
Custom-made wigs for adults are expected to last three years.
Human hair wigs are normally only prescribed to people who for some reason (e.g.allergy) cannot wear a Modacrylic Fibre Wig.

Modacrylic Fibre Wigs

The more commonly prescribed wig is the Modacrylic Fibre stock size wig. The range of styles is now considerable. Again these come without or with monofilament nylon tops. The latter have become more common, are more expensive and not every authority will pay for these.

You must note that it is absolutely not permitted to top up your prescription to get a more expensive wig. You should question this practice with your hospital should you be asked to do so. There should be a wide enough choice for you not to need to consider this, and it’s “illegal” in terms of the NHS Contract.

Patients should be able to see a good choice of styles in suitable shades or, at the very minimum, a shade ring from which a colour can be chosen. No wig supplier, however, can be expected to offer or carry all the styles and all the colours made which one sees e.g. on the Internet and some are just too expensive to come under the NHS umbrella.

How often can I replace my NHS wig?

Custom made wigs are expected to last three years when supplied as a pair, and stock size modacrylic wigs are expected to last one year, again when two are supplied together. Children’s wigs may need to be replaced sooner due to the child growing. Some wearers may feel they need to buy privately between times to keep looking fresh and smart. In this case you should be able to buy at zero VAT if your supplier is VAT registered and has the proper form. It is worth checking first.

Why do some people get a different service?

The decision on what a hospital provides in the way of wigs to people with alopecia is made on a local basis. That means that each hospital will decide for itself how much of a budget there is for wigs. The money a hospital has comes from the local primary care trust (PCT) and each PCT will be in a different financial situation. A lot of PCT’s are currently millions of pounds in debt. Hospitals that are looking to save money will be less inclined to fund human hair wigs. This can lead to what is known as a ‘postcode lottery’.

What can I do if I’m not happy?

If you are not happy with the service you have been offered by your local hospital your first port of call should be the Patient Advice and Liaison Service (PALS) at your local hospital. You can either ring your local hospital switch board or their details will be on the hospital or PCT website.

You can also contact Alopecia UK and we will do our best to advise you and support you.

Alopecia UK is a registered charity No. 1111304