Of 101 PCTs responding to our Freedom of Information Act request, 91% had put in place measures to restrict GP referrals for such procedures. A similar investigation by GP a year ago found two-thirds of PCTs had such restrictions in place.
The restrictions vary significantly from PCT to PCT, meaning patients face a postcode lottery. Some of these restrictions fly in the face of NICE guidance. For many GPs, these restrictions are unacceptable. They mean GPs have to deny patients treatment until their condition worsens.
Of course, the NHS needs to use its resources wisely and difficult decisions have to be made about what can and cannot be afforded. But denying surgery to a patient who would clearly benefit from a cataract operation until their sight further deteriorates is not the answer.
It is also a false economy. Obese patients refused bariatric surgery until they gain even more weight will use more NHS resources overall than if they had surgery earlier.
As GPs point out, these tactics also create hidden waiting lists. There must be countless patients who would benefit from these procedures that are not even allowed on to 'official' waiting lists - yet they are still patients who are waiting for treatment.
Earlier this year the QIPP Right Care Team recommended that the NHS Commissioning Board should develop 'value-based commissioning guidance' for elective surgery. There is clearly an urgent need for such guidance. But it must be developed openly and transparently so commissioners and patients can be assured that the clinical value and demand for these treatments have been properly assessed. What's more, any guidance must be implemented consistently across the country to ensure local areas do not impose additional restrictions.