Restrictions on varicose vein surgery 'too stringent'
By Emma Wilkinson
The number of patients being referred by GPs for treatment of varicose veins has dropped dramatically over the past decade an audit shows.
Surgeons say the figures are down to PCTs rationing surgery to cut costs by setting stringent criteria for referral.
But they warn patients are being let down as there is good evidence that such treatment is cost-effective, can dramatically improve quality of life and prevent future complications.
The analysis of hospital episode statistics shows a 34% drop in the number of patients presenting to secondary care for varicose vein procedures. And in 2007-08 49% fewer patients underwent surgery for varicose veins than in 1998, figures published in the Annals of the Royal College of Surgeons of England show.
The study also found substantial increases in newer minimally invasive techniques such as sclerotherapy but that there remains 'inadequate provision' to NHS patients.
Study leader Professor Gerard Stansby, consultant vascular surgeon at the Freeman Hospital in Newcastle, said PCTs were putting limits on who could be referred and that those limits seemed to vary from region to region.
'They are becoming more stringent in the criteria they set and we don't feel that is very evidence based. Most of the guidelines that people are putting out say referral should be restricted to those with leg ulceration or major morbidity,' he said.
He said that varicose veins can be highly distressing for the patient and it is impossible to tell who will go on to develop severe symptoms and complications.
'Our view is that treatment is cost-effective,' he added
NICE was last month asked by the Department of Health to look at management of varicose veins. It is estimated in the UK that up to a quarter of women and 15% of men have the condition.
Professor Mike Kirby, former GP and primary care researcher at the University of Hertfordshire, agreed there had been a noticeable change over the years in who could be referred for treatment.
'Now patients have to be symptomatic or have complications such as ulcers before they will be treated. But early intervention prevents complications down the line – you only have to look at the number of patients attending chronic varicose vein ulcer clinics to see patients have been left too long.' he said.
'I would agree that a lot of patients have been marginalised and put off because it's been the easy option to cut costs at the time.'
But Dr Stewart Findlay, a GP in County Durham and honorary treasurer of the Primary Care Cardiovascular Society said although in his PCT they had put restrictions in place some time ago they were agreed jointly by primary and secondary care colleagues.
'If they're deemed mild we will not treat them but if they're compromising circulation we will refer,' he said.Restrictions on varicose vein surgery 'too stringent'