Shaping better health
REMEDY : BNSSG referral pathways


Checked: 09-08-2018 by vicky.ryan Next Review: 09-08-2019


Referrals tonsillectomy (or assessment to consider tonsillectomy) for all ages is subject to a prior approval (PA) funding policy:

Tonsillectomy policy


A tonsillolith or tonsillar stone is material that accumulates on the tonsil in crypts or scars caused by previous episodes of tonsillitis. They can range up to the size of a peppercorn and are white/cream in colour. The main substance is mostly calcium, but they can have a strong unpleasant odour.

Tonsilloliths can quite often be removed with a toothbrush and good oral hygiene measures, but they will tend to recur. In addition, patients recurrently manually removing these can cause inflammation and pain themselves.

Although unpleasant and distressing for the patient, they are not an indication for surgical removal of the tonsils and tonsillectomy is not commissioned for these patients.

Please see the Tonsillectomy policy


Referral should only be made if prior approval is in place. Referrals without this approval will be returned by the referral service or by providers.

Referrals for advice can be made to the ENT A and G service via eReferral but please note that prior approval is still required if their advice is to refer.

If PA has been given then refer via eReferral with the funding letter attached.