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Independents' Day

GPs to face new rationing programme for surgery referrals

GPs in London could face new restrictions in referring patients for surgery, including hip and knee replacements.

Under the new plans, hip and knee problems will have to cause ‘a substantial impact on quality of life’ for patients to be referred.

The restrictions come as part of a review of eight surgical procedures, which aims to standardise how people are referred for surgery across the 32 CCGs in London.

The plans for each procedure are being released individually as they are drawn up, with GPs given just two weeks to give feedback.

The ‘London Choosing Wisely’ review, launched by a partnership of commissioners and local government, will look at the following procedures:

  • Surgical removal of benign skin lesions
  • Hip replacement
  • Knee replacement
  • Knee arthroscopy (keyhole surgery)
  • Interventional treatments for back pain
  • Varicose vein procedures
  • Shoulder decompression
  • Cataract surgery

Dr Gary Marlowe, BMA London regional council chair, said the short time frame is ‘worrying’.

He said: ‘This brief window of consultation does not allow for the necessary engagement and clinical input to ensure the best possible outcome and reduced risks to patient safety.’

He added: ‘People expecting key interventions like hip surgery will be adversely affected, and it’s unfair that they could be denied treatment ordinarily available elsewhere.'

Currently, patients waiting for a hip replacement in southwest London are required to have severe pain, or ‘immediate danger of losing their independence’, or the joint could be destroyed, or there is radiological evidence of end-stage osteoarthritis.

Under the new plans, patients will be required to have joint issues ‘that have a substantial impact on quality of life’ and have a radiographic diagnosis of degenerative disease as well as symptoms that don’t respond to non-surgical treatment – such as pain relief.

Dr Vin Diwakar, chair of the London Choosing Wisely steering group, said: ‘My role, as chair of the London Choosing Wisely Steering Group, is to ensure that the process to develop pan London policies is robust and based on the best available evidence.’

He added: ‘As pan-London policies are developed, I will work with steering group members, including clinical leads from across London, to ensure the rigour of this review.

‘Once we are satisfied, policies will be presented to CCG governing bodies for decision.

‘I am confident that this robust process, under clinical leadership throughout, will ensure we arrive at the best policies to improve healthcare by ensuring equality of access across London to all who require treatment for these conditions.’

This comes after the King's Fund warned last year that GPs may soon encounter higher levels of rationing of treatments available for patient referral.

Readers' comments (2)

  • Cutbacks (for a decade), known as rationing, is having a hugely excessive effect on medical decision-making. The books on medical practice and 'decisions in the patient's best interest' are now wrong it would seem. The decisions made are so economical-based that you can forget 'best interest'. Decisions are so often based on cost and services that have not yet been rationed or cut out of the system even. The irony is that the bureaucracy involved in keeping patients at greater than arms length, is reducing still further, any available useful services,treatments or numbers of hospital beds available. As a result, what was the disturbing England death rate last winter? No slack in the system. Does anybody really care. Plenty of anonymous comments but how many will stand up and be counted, write to their MP or have a national march on Parliament? Keep on reading and complying with,dictats on saving the economy,(not saving patients!) Even the GMC are promoters of what's good for the economy of NHS... and putting doctors in untenable, unethical situations all around the nation. Sadly, some in our profession and in CCG's are the puppets of their masters..So a lot more bad decision-making and restrictions on clical decions by doctors will remain uncorrected, and unethical at times, with doctors/GPs and CCGs/ LMC's complicit and nobody ever speaking out...

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  • Robust blah leadership blah, tough decisions, hard working families........yeh doc but my hip still hurts like f@@k
    NHSE just needs to be honest, there is no capacity for elective care, it has become a crisis intervention service and even then is lacking. Broken in so many ways, envy of the world my ar5e

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