This site is intended for health professionals only

LMC leaders criticise ‘shambolic’ implementation of surgery bans for obese and smokers

LMC leaders are reviewing a controversial surgery ban for smokers and obese patients just six months after it was implemented, after large numbers of appropriate referrals were bounced back to GPs.

Pulse reported in July that LMC and clinical commissioning groups (CCGs) leaders in Hertfordshire had narrowly backed moves 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, with GPs also blocked from referring smokers for any orthopaedic surgery until they were referred for smoking cessation.

LMC leaders approved the scheme by just one vote earlier this year, but Hertfordshire LMC said the implementation of the controversial policy had been ‘shambolic' and blighted by administrative blunders, with referrals for patients who met the criteria being inappropriately bounced back to GPs, and hospitals and GPs being given conflicting information on how to implement the policy.

The LMC said hospitals were rejecting ‘the vast majority' of patients referred with hip and knee problems even if they weren't being initially referred for surgery, which it attributed to ‘significant misunderstandings' on how to implement the policy.

Hertfordshire LMC's annual report said although they had narrowly supported the plan, they had expressed concerns at the time about how the policy would work in practice.

The report says: ‘Sure enough, the implementation has been shambolic and next year's annual report will no doubt cover developments on this during 2011/12.'

Speaking to Pulse, Dr Peter Graves, chief executive of Bedfordshire and Hertfordshire LMCs, said: ‘The PCT has admitted communication was poor. Different communications were coming out from different departments of the PCT, containing different information. So hospitals got one lot of information, which was different to what GPs got.'

As a result, Dr Graves said GPs were having to make an appeal against decisions and warned that some patients were ‘slipping through the net'.

He said the LMC had negotiated with the PCT to have ‘a complete review' of the way the policy was communicated, the impact it had had on GPs, and how patients rejected for surgery were faring six months down the line.

‘We want to make sure no patient has suffered unnecessarily and any patient that's still on a waiting list and has not been dealt with, especially if they have met all the criteria, get their surgery urgently', he said.

‘I personally believe that had it been implemented the way we were promised the vast majority of GPs would not have seen nearly as much of an impact that they did see.'

A spokesperson for NHS Hertfordshire said: ‘We are having on-going discussions with the LMC about implementation of the policy on routine surgery for patients with a high BMI and those who smoke.

‘The PCT, together with Hertfordshire's two larger CCGs, is working to ensure effective implementation and will certainly be assessing the impact of the changes being made to the referral pathway.'