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Trusts tighten referral criteria for tonsillectomy

The cuts to ‘low priority' clinical procedures are hitting tonsillectomies, a Pulse investigation shows.

Responses obtained as result of Pulse's FOI investigation, show that overall the average number of tonsillectomies funded by primary care organisations fell by 8% in a year, from 408 in 2008/9 to 377 last year.

And several trusts are clamping down on tonsillectomies by tightening referral criteria.

NHS Bristol tightened its referral criteria in April, raising the threshold to five or more episodes of tonsillitis per year for two consecutive years or seven episodes in one year, from the policy in 2007/8 which required patients to have had five or more episodes for at least a year.

NHS Stockport also raised the threshold in May from five or more episodes in the preceding year to five or more episodes in each of the preceding two years or three or more in the preceding three years.

NHS South Staffordshire said the trust had reviewed their policy in February having been advised by Government information providers Dr Foster Intelligence that ‘there is evidence to suggest that more patients than would be expected are having a tonsillectomy performed'.

The trust has cut the number of procedures it funded from 506 three years ago to 489 two years ago and 470 last year.

PCTs in Lincolnshire, Redbridge and Bexley said they had not funded any tonsillectomies in the past three years.

PCTs were told to clamp down on tonsillectomies by former chief medical officer Sir Liam Donaldson, whose annual report in 2006 annual report cited tonsillectomies as 'an example of the way healthcare interventions are applied with disturbing variability'.

But the statement has been undermined by recent studies, including a Department of Health-funded evaluation that concluded tonsillectomies have clear clinical benefits over medical management of tonsillitis that persist for at least two years, and saved £261 per episode of sore throat avoided.

Experts have predicted that the squeeze on tonsillectomies would become even tighter after the consultancy firm McKinsey identified that an additional £700m could be saved if procedures with limited clinical benefits – such as tonsillectomies, varicose vein removal and some hysterectomies – were no longer performed.

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