Exclusive GPs have signed off a series of sweeping referral restrictions by NHS managers that will bar smokers and overweight patients from being referred for surgery, as PCTs across the country bring in new cost-saving restrictions.
Both LMCs and GP consortium leaders have backed moves by NHS Hertfordshire to block any patient with a BMI over 30 from being referred for routine joint replacement surgery without first being referred to a weight management scheme. GPs will also be prevented from referring smokers for any orthopaedic surgery until they have been referred for smoking cessation.
GPC leaders are seeking legal advice on the controversial plans and are warning that a number of trusts across England have suggested they may follow suit. Locally, the move has driven a wedge between GPs – with consortium leaders divided over the ethics of the restrictions and Hertfordshire LMC backing the plans by just one vote.
Meanwhile, a Pulse investigation covering 41 PCTs has found two-thirds have added new procedures to ‘low clinical priority’ lists since April, as trusts struggle to cut costs.
Procedures subject to new restrictions include the treatment of ganglions in Hampshire and DEXA scanning in primary prevention of osteoporotic fractures in men and women over 50 in Bristol. NHS Warrington has added 13 restrictions, including the treatment of obstructive sleep apnoea.
But it is the restrictions on treatment for smokers and obese patients that have prompted fiercest debate.
Dr Tony Kostick, joint chair of NHS Hertfordshire’s clinical executive committee and chair of East & North Herts GP Commissioning Consortium, insisted the move was based on ‘sound’ clinical evidence.
He said: ‘It’s divisive in the sense some GPs don’t want to confront the rationing debate. We spend fortunes on treatments of limited clinical value.’
A spokesperson for NHS Hertfordshire said the changes had been legally approved, and were necessary to ‘make absolutely the best use of NHS resources’.
But Dr Mike Ingram, chair of the single-practice Red House Consortium and a member of Hertfordshire LMC, said: ‘Patients’ access to services should be based on the care they require and not on a discriminatory policy. I’m very worried about denying people care on the basis they are fat.’
Dr Nigel Watson, chief executive of Wessex LMCs and chair of the GPC’s commissioning and service development subcommittee, said he was discussing the restrictions with the BMA’s legal department.
‘My understanding is you cannot discriminate against patients on the basis of lifestyle choices,’ he said.
Clinical procedures being added to low-priority lists
- Acne scarring treatment
- DEXA scanning in primary prevention of osteoporotic fragility fractures in women and men over 50 years
- Dose-dense temozolomide in recurrent glioblastoma multiforme
- Hip replacement
- Knee replacement
- Treatment of ganglions
- Treatment of obstructive sleep apnoea
- Ultrasound to promote bone fracture healing
Source: Pulse survey of 41 PCTs
MAP: PCTs that have added or revised criteria for treatment they class as ‘low clinical priority’ in 2011
View PCT Low Clinical Priority Lists in a larger map