NHS commissioning group already restricting access to care

NHS commissioning groups already restricting access to care, survey reveals

Hernias, cataracts and infertility among conditions facing tighter criteria for treatment, according to research by the BMJ

Man having his eye examined

Restrictions on treatment for conditions such as cataracts has led to fears that GPs are being forced to become ‘rationers of care’. Photograph: Reuters

Patients are being denied treatment for hernias, cataracts and infertility because the new GP-led groups that control £65bn of NHS funding are imposing new restrictions on access to care, research reveals.

At least 27 of the 211 clinical commissioning groups (CCGs) across England have tightened the criteria for obtaining one or more forms of hospital treatment in 2013-14, the British Medical Journal has established. But, in all, 68 CCGs are looking again at their guidelines on when patients should receive treatment for one or more forms of illness, according to responses from freedom of information requests received from 195 CCGs.

The curbs have brought claims that patients’ health could suffer, that budgetary pressures are being put above patients’ need for treatment and that family doctors are being forced to become “rationers of care”.

For example, Mid Essex CCG has limited patients’ access to surgery for hernias and brought in a series of new criteria, such as whether the hernia is growing in size month on month or whether there is a risk of it becoming strangulated – a more serious condition – because the patient does heavy manual work.

It also now insists that those with Dupuytren’s contracture – when one or more fingers bends inwards towards the palm and cannot be used – have to have it affecting two or more fingers and be “severely impacting on activity of daily living” before action is taken, and that those with trigger finger, which causes pain in the hand, must have at least two injections of corticosteroids at least six weeks apart before they can undergo surgery.

Other CCGs have introduced restrictions on treatment for skin lesions, ganglions and septorhinoplasty – surgery to change the shape of the nose and relieve breathing problems – although others have removed curbs on other treatments they inherited from their predecessor primary care trusts.

And just four of the 195 CCGs told the BMJ that they had implemented advice issued by the National Institute for Health and Care Excellence (Nice) in February that 41- and 42-year-old women should be able to undergo IVF treatment.

Dr Clare Gerada, chair of the Royal College of GPs, said the BMJ’s findings “tell us that the NHS’s budget is dwindling and inadequate, and bear out our fears of GPs being put in the invidious position of being both the rationer and the patient’s advocate. There’s an inherent tension there.”

Dr Steve Kell, chairman of Bassetlaw CCG in Nottinghamshire and a spokesman for NHS Clinical Commissioners, denied that CCGs were rationing care in order to save money. All such decisions were taken on the basis of sound clinical evidence, Kell said. But the country needed to have a conversation about what the NHS can and cannot afford as it tries to reconcile rising demand and flat budgets, he added.

A Department of Health spokesman said that “restricting access to services on the basis of cost alone is wrong and compromises patient care. Decisions should be based on what is most clinically appropriate for the patient.”

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