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Smokers blocked from routine surgery as cost-cutting NHS managers tighten screw on referrals



By Gareth Iacobucci

Exclusive: GPs have been blocked from referring smokers for any routine elective surgery unless patients quit or complete an NHS Stop Smoking course, under a draconian package of PCT cost-cutting measures.

The controversial plans, which have already provoked anger among GP leaders, have been tabled as part of a savage programme of referral caps for hospital procedures, which NHS managers claim are necessary to prevent GP consortia inheriting mountains of debts.

NHS West Kent, NHS Medway and NHS Eastern and Coastal Kent have put forward plans to block GP referrals for a host of hospital procedures until April 2011, including bariatric surgery, IVF, and gender reassignment, as they battle to cut costs.

And NHS West Kent also plans to make all smokers booked for planned surgery to complete an NHS Stop Smoking course prior to treatment, to extend waiting times for routine elective surgery, and to halt all consultant-to-consultant referrals for the rest of the financial year unless clinically urgent.

The measures follow the lead of NHS Surrey, which recently halted referrals for a raft of services, including IVF, in an attempt to tackle its chronic £35m debt.

The three trusts are also looking to GPs to play a greater role in stopping their patients from going to A&E in order to drive down costs.

PCT bosses said the moves were necessary to prevent trusts sliding further into debt ahead of the transition to GP commissioning, but GP leaders said the moves were ‘extremely contentious’ and could put GPs at risk of breaking the GMC’s ethical guidelines.

A letter to all GPs from NHS West Kent said: ‘There is good evidence to show that stopping smoking prior to surgery reduces length of stay and infection rates, and improves healing time; it is also a time when people are often highly motivated to give up. All patients who smoke and are booked for planned surgery will therefore be required to complete a NHS Stop Smoking course prior to surgery.’

‘For patients already on the waiting list this means that the clock will be stopped and restarted at the same point, in accordance with the 18-weeks rules. Going forward, all patients requiring planned surgery should be referred to a NHS Stop Smoking Service before being added to the waiting list. A ‘Non Smoker’ status OR completion of the programme (as opposed to a definite requirement to have stopped smoking) is the threshold for surgical referral.’

The plans come into effect this month, although the PCT has pledged to allow ‘feedback from as wide a range of frontline clinicians as possible’.

NHS West Kent chief executive Marion Dinwoodie said: ‘I regret that we have to take measures in the short term that may have an impact on local people. However, we need to take strong action to deal with the current challenges.’

But Dr John Allingham, medical secretary of Kent LMC, and a GP in Hawkinge, Kent, said GPs were ‘up in arms’ at the plans, and warned the moves could be scuppered by a lack of availability of smoking cessation services.

He said: ‘The plan is extremely contentious and it’s a way of extending the waiting times. If you’ve got to do a 12-week smoking cessation course before you can have your hernia fixed, or before you’ve even gone on the waiting list to have your hernia fixed, it immediately makes those waiting lists another 12 weeks longer.

‘But in terms of delays, it’s only a one-off saving. You can’t repeat that year on year, and it’s dependent upon there being sufficient smoking cessation services to cope with the demand, which we suspect there aren’t.’

He added: ‘We are resisting the proposals to get GPs to restrict referrals because we think that the GMC’s ethical guidelines state that you can’t do that. GPs are up in arms.’

NHS West Kent is to make all smokers booked for planned surgery complete an NHS Stop smoking course prior to treatment NHS West Kent is to make all smokers booked for planned surgery complete an NHS Stop smoking course prior to treatment