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NHS England to save £200m on 17 ‘ineffective’ procedures including tonsillectomy



NHS England has announced plans to scrap four surgical procedures, with a further 13 to be commissioned ‘when certain criteria are met’.

The plans, laid out in NHS England board papers, are expected to save £203.3m in 2019/20.

However, the chair of the BMA said the latest development is a ‘a tough pill to swallow’ after the Prime Minister announced an extra £20bn for the NHS over the next five years.

He added that the extra investment ‘should allow patients to get the care they expect from the NHS, and allow doctors to provide the care they need, not ration it’.

This first phase of the programme will see procedures such as tonsillectomy and carpal tunnel syndrome release surgery rationed, while surgery for snoring will also be cut.

The board papers said NHS England will be consulting on the proposals between 4 July and 28 September, but added that it intends to make this a ‘much wider, on-going programme’ with specialised services included in phase two.

The 17 procedures that will be consulted on in the first phase of this scheme have been based on clinical evidence and research from NICE, the Choosing Wisely recommendations made by the Royal Colleges and NHS Clinical Commissioners’ work on Procedures of Limited Clinical Effectiveness, the papers said.

It said: We propose the programme has a tight initial focus on seventeen interventions where there is clinical consensus and evidence that they should either not be routinely commissioned or should only be commissioned when certain criteria are met.’

It added: ‘The main reason for introducing this programme is to prevent avoidable harm to patients and free up clinical time and capacity. This means reducing activity for these seventeen interventions.

‘Last year, based on an initial assessment, we estimate the seventeen interventions were performed 348,201 times, amounting to £439m spend, although this figure will be subject to further review.

‘We have modelled three illustrative scenarios of the potential reductions in activity we could expect to achieve. Our moderate estimate is a reduction of 168,005 procedures in 2019/20, amounting to £203.3m spend.’

The paper added: ‘We intend to make this a much wider, on-going programme, subject to making sufficient progress in the first phase. We will consult on further interventions in phase two, which will be launched in early 2019.

‘We will keep the list of interventions under periodic review as the evidence base grows in future years. Phase two will also include specialised services, which are commissioned by NHS England.’

However, BMA chair and GP Dr Chaand Nagpaul said: ‘Doctors welcomed news of a long-term funding settlement for the NHS but this latest development will seem a tough pill to swallow.

‘While it’s correct some surgical procedures are now shown to be clinically ineffective, the Prime Minister’s investment should allow patients to get the care they expect from the NHS, and allow doctors to provide the care they need, not ration it. The promised funding is well short of what’s needed to do this and far behind funding of comparable European economies.

‘In a recent BMA survey, three quarters of doctors said that financial targets still override patient care, while the board agendas of NHS organisations across the UK remain obsessed with balancing unbalanceable books.

‘Rather than cut services, the government’s priority should be to stop the scandalous waste of billions of taxpayer money on the damaging NHS market in England, pointless fragmentation of NHS services and outsourcing deals that disrupt patient care.’

Last week the Royal Colleges, which includes the RCGP, urged patients to question their GP about the harms and benefits of tests and treatments they’re being prescribed, while also publishing a list of 50 procedures that they consider to have little value, adding to the 40 avoidable interventions that they published in 2016.

GPs in 32 CCGs in London were already set to face new restrictions in referring patients for surgery, including hip and knee replacements following a review of eight surgical procedures.

Meanwhile, the King’s Fund warned last year that GPs may soon encounter higher levels of rationing of treatments available for patient referral

List of procedures in full:

Four interventions that should no longer be routinely commissioned

  • Surgery for snoring
  • Dilatation and curettage for heavy menstrual bleeding
  • Knee arthroscopies for osteoarthritis
  • Injections for non-specific back pain

13 procedures that will only to be offered when specific criteria are met:

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets for Glue Ear
  • Tonsillectomy for sore throats
  • Haemorrhoid surgery
  • Hysterectomy for heavy menstrual bleeding
  • Chalazia (lesions on eyelids) removal
  • Removal of bone spurs for shoulder pain
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release for tightening of fingers
  • Ganglion excision – removal of noncancerous lumps on the wrist or hand
  • Trigger finger release
  • Varicose vein surgery