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CCGs ration care for obese and smokers with new wave of restrictions

Exclusive GP commissioners and NHS managers across England are targeting smokers and the obese with a raft of new restrictions limiting patients' access to treatment unless they modify their lifestyles, Pulse can reveal.

More than a quarter of PCTs are reporting that new restrictions on surgery based on lifestyle criteria have been introduced in their areas over the past year. But some GPs claim the ‘fat and fags' restrictions are discriminating unfairly against patients, while a senior lawyer warned they could be open to legal challenge on equality grounds.

Freedom of Information responses from 91 PCTs show 25 have brought in new restrictions on treating obese patients or smokers since April 2011, not counting rationing of bariatric surgery. Eleven have introduced restrictions on hip and knee replacements, while nine have targeted IVF. Others have restricted  nipple inversions, breast reconstruction and open MRI scans.

The Peninsula health technology commissioning group, covering Cornwall, Devon, Torbay and Plymouth, is now banning both men and women from undergoing IVF treatment unless they have been non-smokers for at least six months.

NHS Bedfordshire has barred obese patients from hip and knee surgery until after they have lost ‘10% of initial body weight or moved below BMI 35' while NHS North Essex requires patients to ‘have lost at least 5% weight and have maintained that 5% weight loss for at least six months'.

NHS Hertfordshire, which caused controversy last year by banning hip and knee operations for patients with a BMI of more than 30 and for smokers until they attend a smoking cessation course, has now extended the policy to all routine surgery.

Ben Troke, partner at Browne Jacobson LLP, warned the restrictions would have to be drafted carefully ‘to avoid having any discriminatory effect, in appearance or reality, on any particular groups in society'. 

‘The public-sector equality duty, under s149 of the Equality Act 2010, would apply to CCGs in just the same way as it currently applies to PCTs,' he said.

Dr Clare Gerada, chair of the RCGP, said some of the restrictions, particularly for IVF, were ‘dreadful': ‘It's becoming the deserving and the undeserving. I think it's discriminatory and I find it astonishing. The Government should determine what should be applied universally.'

Dr Mike Ingram, chair of Red House CCG, a single-practice group which has been ordered to merge with the neighbouring Herts Valley CCG, said: ‘We are the only practice in Hertfordshire not to be implementing the "fat and fags" policy. I had an email from other practices who wanted to join us.'

Dr Nicholas Small, chair of Herts Valley CCG, said the measures applied to those needing ‘routine surgery only'.


Read the full restricted treatment data document here.