Exclusive: 90% of PCTs are now rationing care
By Tom Moberly, 19 June 2012
More than 90% of PCTs impose thresholds or limits on referrals for procedures deemed 'non-urgent' or of 'low clinical value', a GP investigation shows.
The findings reveal that use of the limits, which can deny patients treatment until their conditions deteriorate beyond NICE thresholds, have risen since a similar GP investigation last year.
GPs and charities accused PCTs of 'introducing waiting lists by the back door' by limiting access to care.
The DH responded to GP's findings by vowing to crack down on PCTs that force patients to wait unfairly.
Of 101 PCTs responding to a Freedom of Information Act request, 91% had measures in place to limit GP referrals for such procedures for 2012/13. Limits on cataract surgery are in place in 66% of trusts, while 59% restrict bariatric surgery and 59% limit joint surgery.
For cataracts, some PCTs will only fund surgery for one eye and some restrict bariatric surgery to patients with BMI over 50. NICE says bariatric surgery should be offered to patients with BMI over 40.
GPC deputy chairman Dr Richard Vautrey called for a national list of low clinical value procedures, to ensure patients are treated fairly.
‘Patients need to be treated fairly and we need consistency,' he said. 'The reality is that this is simply a cost-saving exercise. PCTs now, and clinical commissioning groups (CCGs) in the future, need to be much more open and explain why such lists are needed.’
Waiting for treatment
Kent GP Dr Julian Spinks said PCTs were restricting treatments that would be needed 'sooner or later'.
'They're introducing waiting lists by the back door,' he said. 'People are not getting treatment or having to wait until they get worse, but the government and the NHS can say they're meeting targets.'
National Obesity Forum chairman and Hertfordshire GP Dr David Haslam said the NHS would face 'crippling costs' if bariatric surgery rates fall.
‘Bariatric surgery is amongst the most clinically effective and cost effective area in any field of medicine,' he said. ‘Unfortunately, because of the changes to the NHS, bariatric surgery rates are likely to dwindle, and the NHS will once again be burdened with the crippling costs of diabetes, heart disease and cancer which could have been prevented.’
Clara Eaglen, of the Royal National Institute of Blind People, said that once cataracts affect everyday life, sight only continues to deteriorate. 'Not treating them now will only increase waiting lists in future,' she said.
NICE said it was aware that PCTs had introduced their own criteria for eligibility for bariatric surgery. 'We would hope these criteria would not be implemented unless they were evidence-based and lead to improved clinical outcomes,' a spokeswoman said.
Health minister Simon Burns told GP: 'If local health bodies stop patients from having treatments on the basis of cost alone we will take action against them.’
Dr Vautrey said the current situation left ‘patients feeling very frustrated’. ‘They know that NICE guidance recommends a particular treatment,' he said.
'Where a PCT or CCG has put in place restrictions over and above NICE, they can’t understand it. Patients have said to me "Should I just go away and get fatter?" Patients can find the thresholds for NICE guidance, then they find that it’s not available and they feel let down.’
|Response from health minister Simon Burns|
‘Last year we made it clear that it is unacceptable for the NHS to impose blanket bans for treatment on the basis of costs.
'That is why we banned PCTs from putting caps on the number of people who could have certain operations.
‘Decisions on treatments, including suitability for surgery, should be made by clinicians based on what is most clinically appropriate for the patient and take the individual patient's needs into account.
‘No right-thinking person could possibly understand how anyone could delay a patient's treatment unnecessarily. If patients need treatment, they should get it when they want it and where they want it.
'If local health bodies stop patients from having treatments on the basis of cost alone we will take action against them.’
|Response from NICE|
‘Our clinical guideline on obesity recommends that people with a BMI of 40 or more should be offered bariatric surgery, as long as they have tried and failed to achieve clinically beneficial weight loss by all other appropriate non-surgical methods and are fit for surgery. The evidence shows that bariatric surgery is both clinically and cost effective under these circumstances.
‘We are aware that some PCTs have introduced their own criteria for eligibility for bariatric surgery, which they are within their rights to do. However, if they do so, we would hope that these criteria would not be implemented unless PCT criteria were evidence-based and lead to improved clinical outcomes.’
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