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GPs urged to curb cataract surgery

GPs are being pressed to ration access to cataract surgery to those with the greatest need amid fears the NHS is doing too many of the procedures.

Leading GPs backed the call for a national referral standard and said some patients were probably operated on 'too early'.

Independent sector treatment sectors are adding to the problem, according to one expert.

Investment was poured into cataract surgery in the 1990s following warnings that an ageing population would increase demand. Now researchers from the Oxford Eye Hospital suggest the drive to cut waiting times has gone too far and PCTs are paying for unnecessary operations.

In a study published early online by the British Journal of Ophthalmology, the research team said GPs should be given 'appropriate thresholds for intervention', taking into account symptoms, visual acuity and functional impairment.

Lead author Mr Paul Rosen, a consultant ophthalmic surgeon at Oxford Radcliffe Hospitals NHS Trust, said: 'The fact that cataract surgery has increased so much in recent years raises questions as to whether it is now undertaken too readily.'

His team analysed national data on hospital admissions for cataract surgery in England, finding a five-fold increase from the late 1980s to 2003. There were also wide geographical variations in admissions, ranging from 172 to 548 people per 100,000, suggesting differences in GP referral patterns.

Dr Paul Zollinger-Read, a GP in Braintree, Essex, and GP lead on the Government's National Patient Access Team, said: 'I agree entirely that a restriction is needed. As time has gone by the basis on which we operate has gone down and down. We should operate on those patients whose life is affected, rather than those with a minor visual impairment.'

Dr Zollinger-Read said some areas, including his own, had already begun to use clinical criteria for referring patients.

Dr Mike Dixon, chair of the NHS Alliance, also agreed with the call for GPs to apply a national standard but said independent sector treatment centres were part of the problem. 'The problem in terms of independent sector treatment centres is that in some cases they have contracts for a minimum number of cases with primary care trusts running for another couple of years,' he said.

'Some PCTs feel a little sore that they are having to spend money on something that arguably isn't really needed.'

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