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GPs go forth

CCG restricts treatment for smokers and obese patients

GPs in one area of England will not be able to refer some patients for routine surgery unless they quit smoking or lose weight, it has been revealed.

Northern, Eastern and Western (NEW) Devon CCG said the rationing measure was ‘urgent and necessary’ to be able to prioritise costs whilst tackling a £14.5 million financial deficit.

Under the new rules, smokers will have to quit eight weeks before any kind of routine surgery, while the morbidly obese must lose 5% of their weight or slim down to a BMI of less than 35.

The decision, which has been reached after media reports on plans in the autumn, are stricter than initial proposals which was going to affect knee and hip operations only and would allow smoking up until six weeks before surgery.

The final decision also sees the CCG limiting people to one hearing aid rather than two, restricting treatment for wet age-related macular degeneration (AMD), limiting certain types of shoulder surgery and stopping removal of earwax in hospital.

CCG chair Dr Tim Burke said the measures were not just for saving money but would also help patients.

He said: ‘[These] measures encourage patients to take steps themselves to reduce their risks from surgery and to improve their outcomes, such as losing weight and stopping smoking.’

But he added that there could be exceptions to the rule, saying: ‘We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them. If they are able to do this it will also have long term health benefits for them.’

The CCG stressed that the decisions were ‘interim commissioning positions’ and said it would consult further on them.

But the GPC said rationing of treatments for some patients was an unfair postcode lottery which could backfire on the CCG and local GPs, especially as practice boundaries are removed from January allowing patients to register with a GP away from their home.

Dr Nigel Watson, chair of Wessex LMCs, said that while people would likely have better outcomes if they stopped smoking or lost weight, to exclude people if they were not able to do so was unethical.

He said: ‘Just because someone has been harmed from something like smoking, I don’t think it is ethical not to treat them. There is good evidence that if you stop smoking for four weeks before surgery post-op healing and things like that are better and in our area we strongly encourage people to do that. But it is all about risk management - is the risk of this treatment greater than the benefits? - and at the end of the day I don’t think it’s ethical not to treat them. It should be judged on the individual case and [smoking and obesity] should factor in the risk assessment but not used as an exclusion criteria.’

GPC deputy chair Dr Richard Vautrey said: ‘This sort of postcode rationing has never been helpful – and may backfire on CCGs, particularly with the out-of-area policy likely to be implemented next year, which could mean patients starting to register in other CCGs in order to get services that are not available in their own CCG.

‘And I’m sure GPs in the CCG will be frustrated they are not able to offer the same comprehensive range of services to patients in their area as they would get anywhere else in England.’

He added: ‘It’s a sign of how desperate the financial situation is for that particular CCG, but it’s unfair that patients in their area are having this impact on their care.’

The news comes as Pulse revealed that local area teams of NHS England were rationing what minor surgery GPs could do under the national enhanced service.

Readers' comments (7)

  • Vinci Ho

    Putting the argument whether this is right or wrong aside, one would like to know how much NHSE had influenced this CCG and obviously hidden behind the screen when this decision was announced?
    With more austerity on the horizon , this type of debatable rationing will likely roll out to other CCGs.......

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  • I wonder if the surgeons who now cannot operate on these patients on NHS will be able to do those same operations on the same patients on their private lists (as can GPs set up private clinics to deal with things no longer eligible for NHS funding). And will 1 cataract be paid for via NHS budget and one by patient's private health insurance (top up fees via stealth)?

    The core NHS principles no longer apply - that the health service will meet the needs of everyone, be free at the point of delivery and healthcare will be delivered according to clinical need, not the ability to pay

    Our NHS is being dismantled at an alarming rate and this is a deliberate. £2 billion 'underspend' was returned to the treasury despite CCGs everywhere being in deficit and there is so much obfuscation in this government's pre-election announcements about NHS funding it is dizzying.

    We feel powerless even though we, the GPs, are supposed to be 'in the driving seat' though I don't think anyone believes that spin except when they want us to shoulder the blame for this appalling chaos. We can't do much but we can get behind any of the number of campaigns such as:

    Back Allison Pollock's campaign for the NHS reinstatement bill.

    If nothing else it might help channel our anger and frustration.

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  • I feel it is important that patients are made aware of the risks during / following surgery due to their current lifestyle?

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  • While I am against cuts and depriving patients of choices, I strongly feel that patients need to take responsibility for their care an well-being. It doesn't quite sound right when an obese person refuses to change habits and ends up with money spent on the individuals surgery but with obesity again within 12-18 months or, worse, complications of dvts etc.
    Not going into the ethics of this decision, there does seem to be a point here.

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  • Wholeheartedly agree - the mollycoddling approach to patients, who are encouraged to act as consumers and complain to get what they want now need to accept responsibility for the state of the NHS and the impact their lifestyle choices have on their health.
    And, yes, obesity and smoking increase risks of surgery, and now that surgeons have their ratings etc published, they will be more mindful of taking on those risks.

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  • Nhshould treat all patients who are in need. These decisions are always made by those who do not need those treatments

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  • Nhsfatcat

    The NHS was set up when the country was on it's knees financially. The mantra of unaffordability has finally worn through to everyone.
    When we are all complicit in this the NHS dies.

    "When bad men combine, the good must associate; else they will fall one by one, an unpitied sacrifice in a contemptible struggle"

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