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GPs to be given rationing thresholds for surgery



GPs will be given thresholds to ration 28 common surgical procedures such as hip and knee replacements, cataract surgery and bariatric surgery under new guidance currently being developed by the Department of Health.

DH officials revealed that the guidance is currently being developed with the Royal College of Surgeons and NICE, with 28 bits of guidance set to be unveiled in June this year. The guidance will outline when to offer the procedures on the NHS and when to refuse patients the treatment.

NHS medical director Sir Bruce Keogh told MPs on the House of Commons Public Accounts Committee that the guidelines would help achieve the so-called ‘Nicholson challenge’ to save the NHS £18.9bn by 2015.

He said: ‘People don’t like, as you notice, talking about rationing, but people have to make choices, particularly those who are responsible for delivering healthcare.

‘People reasonably expect that they will get similar treatment in one part of the country as another. The whole business of QIPP is really about how we maintain clinical and service quality in the face of increasing demand, and relatively static resources.

‘That means that we need to ensure that we have the right supporting infrastructure for delivery of our services, and also that we need to start looking at appropriateness of care and value.

‘So what we are trying to get to is how we can get a clinical consensus around the country, about how you offer the right treatment at the right time.

‘The main areas that I get confronted with are… hips, cataracts – varicose veins would be another example – some pretty common surgical procedures. So we have started to work with the Royal College of Surgeons, on a programme which we call “value-based commissioning of elective surgical care” and in conjunction with NICE we have established a process that will define the appropriate thresholds of care.

‘That process will be overseen by the Royal College of Surgeons and quality-assured, but the work will be done by other specialist associations, so for example the vascular surgeons or the plastic surgeons, or whoever. We are just entering into the second phase of that so the processes and the methodology are being worked out so that by June this year, we will have 28 bits of guidance.’

The DH is also evolving the system into a tool that can be used by patients to compare services across the country.

Sir Bruce added: ‘But interestingly, and one of the things that excites me the most, is that we will have a thing called the “procedures explorer”, which will be open to the public and people in the NHS, where you will be able to see which procedures are being carried out in which volume, and hopefully with what outcome although that is more complex for some of these procedures, for each CCG and will be divided into different regions, so providers, regions and different levels.’

But, Dr Mark Porter, chair of the BMA, said: ‘Decisions about patient care should be based firmly on sound clinical evidence with the involvement of both doctors and patients. In our NHS, it is vital that treatment guidelines are focused on what is best for the patient. It will be hard for the public to understand or agree with rationing decisions based on financial restrictions.’