Regions seeking to ration access to elective care services by introducing new thresholds or ‘lifestyle’ criteria, like stopping smoking, must now seek pre-approval from NHS England ‘at least four weeks’ in advance.
NHS England has written to CCGs across the Yorkshire and the Humberside region after recent media and political interest in local commissioning initiatives that have sought to ban bariatric surgery, freeze IVF, and cut vasectomy referrals.
A letter from NHS England (Yorkshire and Humber) published by NHS Rotherham CCG says pre-approval will allow it to ‘support and assure’ the CCG’s work and brief its national teams to ensure ‘consistent messages’.
The letter is dated 15 March, prior to Prime Minister Theresa May’s decision to call a snap general election, and says criticism of rationing by the Royal College of Surgeons (RCS) and debate in the House of Commons was a key consideration in the new policy.
The RCS has previously written to commissioners who have restricted surgical referrals warning this ‘would act as a barrier to patients receiving necessary clinical treatment’.
More recently CCGs struggling to balance the books have contemplated even more extreme rationing, including a two-month ban on GPs referring for non-urgent outpatient appointments.
The letter says: ‘The purpose of this letter is to ask that you inform NHS England at least four weeks in advance of updating policies or publishing new commissioning guidance to manage or restrict access to elective services by setting or changing severity criteria, pre-referral pathway requirements or lifestyle thresholds.
‘The context is of recent media interest in the introduction by CCGs of restrictions to elective services, criticism by some organisations such as the Royal College of Surgeons, political interest, a House of Commons debate and requests for information from the NHS England central communications team (who in many cases have not had prior notification, because we have not had prior notification).’
It added that NHS England is ‘very supportive’ of commissioners’ work to manage their resources, and acknowledges ‘difficult decisions need to be made’ and says this is something other CCGs will be considering as well.
The rise of CCG rationing
Commissioners have come under criticism for making increasingly desperate attempts to ration treatment, after large numbers of CCGs were rated poorly for financial management by NHS England – with several racking up multimillion-pound deficits.
NHS Basildon and Brentwood CCG provoked criticism by announcing plans to completely ban referrals for bariatric surgery.
The CCG also followed the lead of neighbouring CCGs in proposing to completely stopping funding for both male and female sterilisation as well as cutting back on some treatments, such as limiting IVF.
Other CCGs facing large deficits also planned cuts to GP enhanced services that were branded ‘short-sighted’ by local GP leaders.
Last year St Helens CCG was forced to drop plans to stop GPs referring patients for elective treatment over the winter, after outcry from the profession and the public.