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CCG restricts treatment for smokers and obese patients



GPs in one area of England will not be able to refer some patients for routine surgery unless they quit smoking or lose weight, it has been revealed.

Northern, Eastern and Western (NEW) Devon CCG said the rationing measure was ‘urgent and necessary’ to be able to prioritise costs whilst tackling a £14.5 million financial deficit.

Under the new rules, smokers will have to quit eight weeks before any kind of routine surgery, while the morbidly obese must lose 5% of their weight or slim down to a BMI of less than 35.

The decision, which has been reached after media reports on plans in the autumn, are stricter than initial proposals which was going to affect knee and hip operations only and would allow smoking up until six weeks before surgery.

The final decision also sees the CCG limiting people to one hearing aid rather than two, restricting treatment for wet age-related macular degeneration (AMD), limiting certain types of shoulder surgery and stopping removal of earwax in hospital.

CCG chair Dr Tim Burke said the measures were not just for saving money but would also help patients.

He said: ‘[These] measures encourage patients to take steps themselves to reduce their risks from surgery and to improve their outcomes, such as losing weight and stopping smoking.’

But he added that there could be exceptions to the rule, saying: ‘We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them. If they are able to do this it will also have long term health benefits for them.’

The CCG stressed that the decisions were ‘interim commissioning positions’ and said it would consult further on them.

But the GPC said rationing of treatments for some patients was an unfair postcode lottery which could backfire on the CCG and local GPs, especially as practice boundaries are removed from January allowing patients to register with a GP away from their home.

Dr Nigel Watson, chair of Wessex LMCs, said that while people would likely have better outcomes if they stopped smoking or lost weight, to exclude people if they were not able to do so was unethical.

He said: ‘Just because someone has been harmed from something like smoking, I don’t think it is ethical not to treat them. There is good evidence that if you stop smoking for four weeks before surgery post-op healing and things like that are better and in our area we strongly encourage people to do that. But it is all about risk management – is the risk of this treatment greater than the benefits? – and at the end of the day I don’t think it’s ethical not to treat them. It should be judged on the individual case and [smoking and obesity] should factor in the risk assessment but not used as an exclusion criteria.’

GPC deputy chair Dr Richard Vautrey said: ‘This sort of postcode rationing has never been helpful – and may backfire on CCGs, particularly with the out-of-area policy likely to be implemented next year, which could mean patients starting to register in other CCGs in order to get services that are not available in their own CCG.

‘And I’m sure GPs in the CCG will be frustrated they are not able to offer the same comprehensive range of services to patients in their area as they would get anywhere else in England.’

He added: ‘It’s a sign of how desperate the financial situation is for that particular CCG, but it’s unfair that patients in their area are having this impact on their care.’

The news comes as Pulse revealed that local area teams of NHS England were rationing what minor surgery GPs could do under the national enhanced service.