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16.07.14

CCGs restricting patient access to ‘vital’ operations – RCS

Some clinical commissioning groups (CCGs) are imposing ‘arbitrary’ referral restrictions and denying access to vital surgical procedures, according to a new report by the Royal College of Surgeons (RCS).

In its study – Is Access to Surgery A Postcode Lottery? – the college found that 73% of CCGs reviewed do not follow NICE and clinical guidance on referrals for hip replacements, or have no policy in place for this procedure.

Of the CCGs reviewed, 16 imposed the Oxford hip score threshold as part of a case management approach. But the British Orthopaedic Association and the British Hip Society make clear that there is no evidence for using the Oxford hip score as a screening tool. Its use in setting thresholds or prioritising patient access to surgery is therefore “not appropriate”.

The RCS report, which analysed the commissioning policies of 52 CCGs (27% of the total 211 CCGs), also revealed that over two-fifths require patients to be in various degrees of ‘pain and immobility’ – with no consistency applied across the country – or to lose weight before surgery.

Tonsillectomy, the removal of tonsils, is one of the most common surgical procedures on the NHS and is predominantly performed on children. But two CCGs had minimum ‘watchful waiting’ periods, meaning that some patients may not have the surgery for a year and a half. Eight CCGs also required documented absence from school or work.

Clare Marx, president of the RCS, said: “This report seems to show that local commissioners are imposing arbitrary rules governing access to some routine surgery.

“The motivation may not be financial but it is clear that some CCGs do not commission services using clinically accepted evidence-based guidance.”

The RCS has stated that CCGs are faced by a number of pressures, but has suggested that in order to deliver evidence-based commissioning policies they should be reviewed against RCS, NICE or surgical specialty association’s guidance.

It has also been recommended that the government and NHS England need to review what further action is required to ensure the NHS is providing ‘equitable’ access to high quality surgical care.

Responding to the report, Dr Steve Kell, co-chair of NHS Clinical Commissioners (NHSCC), the body representing CCGs, and chair of NHS Bassetlaw CCG, said “CCGs are clinically led organisations that make clinically led decisions centred on the needs of their patients and local populations and to insinuate that their motivation is purely financial is wrong.

“There must be a balance between local decision making and national guidelines and NHSCC will be working with NICE and others to make sure that happens. In my CCG, for example, we have designed best practice guides with the local consultants to improve primary and secondary care management which replaced the old system where patients needed prior authorisation. This kind of locally designed work is going on right across the country.”

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

Comments

Shivam   16/07/2014 at 17:35

Although Dr.Kell reassures that local customisation of clinical guidelines is done with clinical concensus and inputs he does not confirm that it is evidence based. There are too many local ad- hoc decisions being made on "clinicians experience" or " preference". And when led by CCGs such decisions are almost always led by cost and financial factors rather than clinical evidence based practice.

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