This site is intended for health professionals only

Ministers draw up national list of ‘low clinical priority’ operations

By Lilian Anekwe

Exclusive: GPs face a fresh crackdown on referrals for 'low clinical priority' operations, after the Government said it had begun to compile a national list of procedures that they should not refer patients for.

NHS medical director Sir Bruce Keogh has revealed the Department of Health is to work with the RCGP and other bodies to identify 'ineffective operations' which will be decommissioned.

A DH spokesperson told Pulse Sir Bruce 'is concerned about this issue and has already collated PCT lists that are now being reviewed by SHA medical directors'.

The details came in response to a report by Government spending watchdog the Audit Commission, published today, looking at low clinical value treatments and procedures.

The report estimates the NHS could save up to £500 million a year by carrying out fewer 'ineffective or inefficient treatments', but is set to reignite the debate on the rationing of treatments and drugs as NHS managers seek to make efficiency savings.

The commission called for national guidance for commissioners to guide their decisions 'about which procedures to decommission and where to invest their limited money'.

Although the commission specifically said it was not 'advocating any particular list', the types of low value treatments identified include tonsillectomy, hysterectomies in cases of heavy menstrual bleeding and potentially cosmetic procedures, such as orthodontics.

The report recommends PCTs could reduce the number of procedures by monitoring GPs' performance to spot any GP whose referrals deviate from low clinical priority lists, warning that 'PCTs will lack credibility if they do not do this'.

'Contracts should be updated to reflect and, if necessary, enforce the policy,' the report says. 'PCTs need to be prepared to withhold payments or the policy itself will be ineffective.'

The report, 'Reducing expenditure on low clinical value treatments', admits some PCTs may find that the financial savings achieved through cracking down on procedures 'will not be worth the effort of changing referral and clinical practice', but ultimately concludes that performance management is crucial as the NHS will not make savings 'without putting effort in'.

Andy McKeon, managing director for health at the Audit Commission, said: 'PCTs across the country are currently paying for treatments that cost the taxpayer money, and according to clinical experts have little or no real value to patients. This needs to change.'

'A single national evidence base would reduce variation in the treatments available and duplication of effort,' he added.

David Stout, director of the NHS Confederation's PCT Network, also called for central guidance, saying 'a clear and definitive national policy on what treatments are deemed "low clinical value" would be helpful to avoid disputes between commissioners and providers and to provide clarity to patients'.

The Department of Health is ready to heed the call. Sir Bruce said: 'We are working with the colleges and surgical specialty associations to identify what effective operations the NHS should purchase and which ineffective procedures we should be withdrawing from. This provides the opportunity to direct taxpayers' money towards effective rather than ineffective treatments.'

But he added: 'We would not recommend creating definitive lists of ineffective or inefficient procedures without a clear consensus from clinicians who are experts in the field.'

'There must be no blanket bans because what is suitable for one patient may not be suitable for another with different medical or personal circumstances.'

Click here to read the full report

Tonsillectomy is one of the 'low priority' procedures identified by the Audit Commission Audit Commission report