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Placing caps on community surgery will not benefit patients or the NHS



From Professor Vijay Kumar, President of the Association of Surgeons in Primary Care (ASPC)

In a world where transformational care and patient-centred care are in vogue, it makes no sense to place limits or bans on the numbers of vasectomies carried out.

I have worked as a community surgeon for 14 years and hold several national and regional roles, including President of the Association of Surgeons in Primary Care, Chairman of Royal College of GPs Yorkshire, and board member for the Association of Surgeons of Great Britain and Ireland, but I should stress the views I present here are my own.

We should be very proud to say that surgical procedures have been carried out in the community for many years in Britain. GP surgeons have been paid only a fraction of the money that hospitals charge to carry out vasectomies. I am aware in some parts of the country GPs are paid less than 30% of the cost for a vasectomy in the community compared to those carried out in hospital. We should truly embrace a service that provides local services by local doctors at the local practice, at a convenient time and so on, but the cuts do not fit in with this model. Nor do they fit with vertical integration of seamless care delivery, removing inappropriate services from secondary to primary care.

Several reports including the Five Year Plan by Simon Stevens have recognised that procedures carried out in primary care are very cost effective and are done at fraction of the tariff.

Capping the number of vasectomies will not benefit the patient or the NHS. The cost of carrying out the procedure in secondary care is higher and so is the cost to the patient in terms of travel, parking charges, taking time out of work, as well as suffering long waiting lists. It certainly discriminates against couples where the woman is unable to use other methods of contraception as the cost of an unplanned pregnancy is colossal.

The ASPC (alongside the RCGP and ASGBI) has been at the forefront of providing services in the community that are cost affective, truly patient centred, and improve patient satisfaction as well as supporting community surgeons (both GP surgeons and consultants) who operate in the community.

Given the additional burden in costs and manpower that will be incurred by secondary care as a result of such caps, removing such services would be doing a disservice to the patients, staff working in the community and to the NHS as a whole.