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NHS to block GP referrals for surgery to save cash

By Gareth Iacobucci

NHS leaders plan to cut millions from the budgets of primary care organisations by blocking GPs from referring patients for a series of common surgical procedures, Pulse can reveal.

The NHS confederation has told PCOs to urgently look at ‘raising treatment thresholds' for cataract, hernia and varicose vein surgery, warning vast sums are being wasted on operations that are not needed.

Patient questionnaire studies have indicated all three operations, and many for hip and knee replacement, are often performed unnecessarily or are of little help.

But GPs warned rationing operations purely on the basis of short-term assessments of effectiveness was unreliable and could inappropriately deny patients treatment.

The NHS Confederation's report, Commissioning in a Cold Climate refers to controversial results from the Department of Health's pilots into patient-reported outcome measures, or PROMs, finding patients were often referred for operations even though their quality of life was not significantly impaired.

The pilots also evaluated effectiveness of common operations after 12 weeks, and found cataract, hernia and varicose vein surgery, and hip and knee replacements, often delivered little or no improvement in quality of life.

The document says the pilots pave the way for the NHS to ‘introduce tighter criteria and raise treatment thresholds in some cases'.

It admits: ‘On first consideration this appears to be a particularly contentious option, as it suggests the universal NHS offer is being reduced. But it adds: ‘This assumes every service the NHS provides adds value. Evidence from recent pilot studies suggests this is almost certainly not the case.'

David Stout, head of the PCT Network, said given the financial climate the NHS had no choice but to look at where it could make cutbacks: ‘We really can't afford not to be doing this and doing it quickly.'

But GPs warned of the dangers of relying too heavily on PROMs, which were designed as comparative tools to help patients choose between hospitals.

Dr John Tisdale, a full-time primary care surgeon in Truro, Cornwall, acknowledged the need to ration some procedures, but said there was a risk ‘severe pathology' could be missed: ‘PROMs are quite difficult to judge. I've looked seen people filling these forms in, and quite often they haven't really thought it through.'

Dr Adrian Midgley, a GP in Exeter, questioned the value of asking patients how they felt just 12 weeks after surgery. ‘If you operate on someone, you need to know how they feel the following year, not when the stitches come out.'

Surgical procedures such as hip replacements could be on the way out to save cash Surgical procedures such as hip replacements could be on the way out

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