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GPs demand awareness campaign to explain new rationing scheme to patients



GPs are concerned they will be left to explain to patients why certain treatments are being rationed under a new NHS scheme and are calling for a national awareness campaign to tackle the issue.

This comes after NHS England issued new evidence-based interventions (EBI) guidelines to all CCGs – which restrict the referral criteria for 17 surgical interventions including grommets, tonsillectomy and haemorrhoids, which it said are ‘of little or no value to patients’.

While NHS England said the changes will free up GP time, GPs argued it is ‘unfair’ that such measures are brought in without addressing how they are communicated to the public, and said they will be forced to spend appointments explaining the restrictions to unhappy patients.

The EBI programme, published at the end of November, lists four interventions – knee arthroscopy with osteoarthritis; dilation and cuterrage for heavy menstrual bleeding; injection for nonspecific low back pain without sciatica; and intervention for snoring (not OSA) – which it says should not be routinely offered to patients unless there are exceptional circumstances.

A further 13 interventions should only be offered to patients when certain clinical criteria are met, according to the guidance.

An NHS England spokesperson said: ‘This guidance which has been developed with GPs and patients will safely reduce the use of treatments which are not well supported by clinical evidence of benefit. GPs have always helped lead the drive for rational and evidence based medicine for NHS patients, and this is just another practical example of that.’

But GPs warned that unless the guidance is supported by a national public awareness campaign, appointment time would be taken up by having to explain the changes to patients or go through a lengthy process to get them access to the restricted interventions.

Hull GP and BMA GP Committee’s sessional subcommittee chair Dr Zoe Norris said: ‘Patients will still come in asking for these procedures so it won’t save any time in appointments. It is not fair for the government and NHS England to make these changes and then not address how this will be communicated to the general public.

‘It was previously a CCG issue so it was a postcode lottery whether you could get access to these treatments or not but this is a national policy – where is the national campaign to support it? A lot of these treatments are restricted anyway, the problem is it is left to me to explain to patients in a 10-minute consultation why they cannot have breast reduction, tonsillectomy, etc. Why do I have to do this if this is a national policy?’

Doncaster LMC chief executive officer Dr Dean Eggitt said: ‘I am used to saying to patients that it’s not me, it’s the Government making these decisions. I regularly post our local MP’s details on the practice’s Twitter account telling patients to get in touch if they don’t like a change in policy. But I am sick of it being my fault that these services have been removed.’

The new intervention guidance is linked to NHS England’s bid to restrict GP prescribing of ‘low value’ items, on which NHS England launched a new consultation last week.

In November, GPs were told by Government that they would no longer be able to prescribe the majority of gluten free foods, with the exception of bread and mixes, as part of a cost saving drive. The decision came despite concerns being voiced over possible ‘unintended consequences’ of the new legislation.

GPs may also be told to no longer prescribe blood glucose testing strips and bath and shower emollient preparations. The two items feature in NHS England’s latest consultation on prescribing of ‘low value’ items.

In full: Interventions being restricted as part of the Evidence-Based Interventions Programme

Category 1 – should not be routinely offered to patients unless there are exceptional circumstances:

  • Intervention for snoring (not OSA)
  • Dilation and cuterrage for heavy menstrual bleeding
  • Knee arthroscopy with osteoarthritis
  • Injection for nonspecific low back pain without sciatica

Category 2 – should only be offered to patients when certain clinical criteria are met:

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets
  • Tonsillectomy
  • Haemorrhoid surgery
  • Hysterectomy for heavy bleeding
  • Chalazia removal
  • Shoulder decompression
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release
  • Ganglion excision
  • Trigger finger release
  • Varicose vein surgery

Source: NHS England