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GPs to face new rationing programme for surgery referrals



GPs in London could face new restrictions in referring patients for surgery, including hip and knee replacements.

Under the new plans, hip and knee problems will have to cause ‘a substantial impact on quality of life’ for patients to be referred.

The restrictions come as part of a review of eight surgical procedures, which aims to standardise how people are referred for surgery across the 32 CCGs in London.

The plans for each procedure are being released individually as they are drawn up, with GPs given just two weeks to give feedback.

The ‘London Choosing Wisely’ review, launched by a partnership of commissioners and local government, will look at the following procedures:

  • Surgical removal of benign skin lesions
  • Hip replacement
  • Knee replacement
  • Knee arthroscopy (keyhole surgery)
  • Interventional treatments for back pain
  • Varicose vein procedures
  • Shoulder decompression
  • Cataract surgery

Dr Gary Marlowe, BMA London regional council chair, said the short time frame is ‘worrying’.

He said: ‘This brief window of consultation does not allow for the necessary engagement and clinical input to ensure the best possible outcome and reduced risks to patient safety.’

He added: ‘People expecting key interventions like hip surgery will be adversely affected, and it’s unfair that they could be denied treatment ordinarily available elsewhere.’

Currently, patients waiting for a hip replacement in southwest London are required to have severe pain, or ‘immediate danger of losing their independence’, or the joint could be destroyed, or there is radiological evidence of end-stage osteoarthritis.

Under the new plans, patients will be required to have joint issues ‘that have a substantial impact on quality of life’ and have a radiographic diagnosis of degenerative disease as well as symptoms that don’t respond to non-surgical treatment – such as pain relief.

Dr Vin Diwakar, chair of the London Choosing Wisely steering group, said: ‘My role, as chair of the London Choosing Wisely Steering Group, is to ensure that the process to develop pan London policies is robust and based on the best available evidence.’

He added: ‘As pan-London policies are developed, I will work with steering group members, including clinical leads from across London, to ensure the rigour of this review.

‘Once we are satisfied, policies will be presented to CCG governing bodies for decision.

‘I am confident that this robust process, under clinical leadership throughout, will ensure we arrive at the best policies to improve healthcare by ensuring equality of access across London to all who require treatment for these conditions.’

This comes after the King’s Fund warned last year that GPs may soon encounter higher levels of rationing of treatments available for patient referral.