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Gold, incentives and meh

GPs face increasing restrictions as NHS rations care to save money

Exclusive GPs face increasingly tighter restrictions on their ability to refer for specialist care, reveals an investigation by Pulse into plans drawn up by the most cash-strapped CCGs in the country.

The investigation reveals that CCGs are introducing policies that cap surgical referrals, require overweight patients to go a on a ‘weight loss programmes’ before an operation and deny hard-of-hearing patients hearing aids and audiological care.

The investigation comes as GPs say they are finding it harder to refer for surgical treatment of conditions like ganglions or carpal tunnel and, in one area, requests for hysterectomies are simply being ‘fobbed off with a Mirena coil’.

More than a third (36%) of GPs told Pulse they are facing new constraints on services to which they were previously able to refer.

The investigation comes as the health service prepares to implement £22bn of efficiency savings by 2020. But only two years after coming into existence, 19 CCGs have been ordered by NHS England to devise emergency plans to cut their budget deficits. A Pulse analysis of their recovery plans reveals:

  • NHS Luton CCG says, ‘when appropriate, patients must stop smoking and/or undergo a weight loss programme’ before certain elective procedures.
  • NHS North Staffordshire CCG said hearing aids will no longer be routinely provided for patient diagnosed with a mild hearing loss. Campaigners from Action on Hearing Loss labelled the decision ‘cruel’
  • NHS Great Yarmouth and Waveney CCG demands that smokers give up, and obese people lose weight prior to hip and knee replacement therapy and this could be ‘rolled out to other surgical procedures’.
  • NHS Basildon and Brentwood CCG has capped the numbers of vasectomy referrals that individual practices can make.
  • NHS North East Essex CCG has a £22m funding shortfall and has had to put in a range of restrictions on vasectomies, female sterilisation and spinal physiotherapy to save £1m.
  • NHS Mid Essex CCG has a ‘restriction policy’ for 2015/16 on services including acupuncture, facet joint injections and hip and knee operations.

NHS North East Essex CCG chair Dr Gary Sweeney explained: ‘We have no choice other than to stay within budget. If we do not implement these decisions we will have to select other services to restrict.’

Austerity NHS: What are GPs saying?

‘Women needing a hysterectomy are being fobbed off with a Mirena coil.’

GP in Hampshire

‘Referrals are downgraded regularly and we are increasingly scrutinised to ensure ‘appropriate’ referrals

GP in Neath

‘We have seen a rise in follow-up waiting times with patients being told by their consultant they’ll be seen in x months, but it’s increasingly quite unrealistic leading to patients making unnecessary appointments with GPs because they’ve not heard anything.’

Dr Richard Vautrey, GPC deputy chair

‘A grossly obese woman (BMI 60) had a request for lifesaving bariatric surgery refused, meaning further hoops, hurdles and delays.’

Dr Chris Nevill, Powys

Click here to read the full investigation

NHS Alliance chair Dr Michael Dixon, agrees: ‘CCGs are caught between a rock and a hard place. They try to meet tough budgets and get vilified in the process.’

But Dr James Kingsland, president of the National Association of Primary Care, says that such moves are ‘unacceptable’. He said: ‘The idea of rationing necessary care in a service that is free at the point of use is just unacceptable. Any health commissioning body looking at rationing services need to question whether they are fit for purpose.’

GPC deputy chair Dr Richard Vautrey says the financial pressure is often hidden. He says: ‘Where patients may have waited three months, they now wait six – this sort of thing is difficult to measure. Until we get new funding into the NHS we will continue to come under financial pressure and it will get worse.’

Rationing survey results



















Readers' comments (26)

  • The information on the e-referral system is also rubbish. Most waits are now considerably longer than those published. This has resulted in some difficult phone calls from patients. I am fed up of apologising for the state of the NHS. I hope my local PALS team get fed up of me forwarding patients to them.

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  • Stupid idea to privatise it all - so almost no-one can then afford healthcare - leading to empty clinics and hospitals drooling to get patients. US model of care leads to whole populations left without access to medications and care - forcing Obama to try and bring basic care back for them

    Or simply advertise that the NHS there for patients who need, not want things, and rebalance expectations and reduce demand back to more manageable levels.

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  • @Anonymous | GP registrar | 30 July 2015 8:46am
    "the NHS was never designed to be free at point of use. it was free at point of need. Patients often have too high expectations leading to inappropriate referrals, leading to them clogging up the system and delaying patients in genuine need.
    Can't really blame them though when the Government continuously stokes demand advising the UK and the world that they should be entitled to get what they want when they want it where they want it how they want it no matter the reason the want it."


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  • I personally don't have a problem with expecting smokers to stop and the obese losing weight before limited resources are provided to them

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  • Repeat after me:
    1.The USA is not the rest of the world.
    2. Countries in Europe have mixed health economies with excellent coverage.
    3. Not NHS =/= a return to the 1950s.

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  • Get rid of CCGs and then GPs can do what is clinically needed and turn their back to the shouting managers and administrators.

    Better a grump administrator than a gleeful lawyer.

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  • Forget about FREE at the point of need! Whatever happenned to AVAILABLE at the point of need?

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  • The NHS has been one way to deliver the laudable aim of universal health care. There are many other ways to do this and they should be looked at carefully. If this means some form of co-payment so be it, providing those who cannot pay are protected.

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  • Vinci Ho

    You see. It is cunning politics to devolve more 'power' to CCGs as well as forthcoming political power houses. The way it goes , some fee payment from patients to supplement NHS service will become almost inevitable . Typically , Tories will serve for low tax ideology but also not play political 'suicide' to raise anything leading to the accusation of privatisation . So strangulate whatever is available in current NHS and pass the buck of making decisions to CCGs and the local Mayors. Here you go , if a fee needs to be charged , it is not coming out of the mouth of the PM , Chancellor or Health Secretary .
    'You bas***ds in charge of the CCGs/power house will have to explain to the public why you have to be rationing and also charge a fee.' Well, well , well,you guys asked for more power , here is the f***ing power.
    The central government can wash its hands and DoH remains politically righteous . Remember 'Big Society' ? You guys in the society have to sort out any mess , it is not our responsibility in the central government !!

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  • the cost savings by NHS begs questioning.
    They recommend and still doctors use the old Hypoglycaemia inducing Sulphonyulurea in Diabetes now replace by NICE with meal time sulphonyureas repaglinides,which could lower hypos with sulphonylureas in common usage, not prevent metabolic complications MI,CVA,Renal Failures,Blindness,amputations ,which glycosuria inducing ,more expense to purchase Dapagliflozinwe (Forxigo)could.The costs to NHS for diabetes is over two billion pounds p.a. out of which the largest share of costs is in treating secondary complication.The Gliclizides and Glimepirides in use frequently cause hypos which treatment in secondary care according to prof Tony Barnet is hundreds to thousand pounds for each case .
    Mr Julien Given of Blue River Consulting Ltd of Newcastle had presented a paper at PriMed Conference I attended and proved from statistics if GPs were allowed slightly more expensive but cost saving in drugs it would save enormous costs to nHs in short and long term

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