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CCG tightens up pre-surgery requirements on BMI and smoking

Escalating demand and deficit leads to greater restrictions on planned surgery

Louise Prime

Thursday, 04 December 2014

A clinical commissioning group with predicted deficits for this year of over £14m has extended requirements on weight management and smoking before planned surgery, in order to prioritise essential services. North, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) said the temporary restrictions would help it to comply with its legal duty to live within its financial resources.

Last month NEW Devon CCG said it would have to take “urgent and necessary” steps to prioritise the requirements set out in the NHS Constitution. It said morbidly obese patients (body mass index ≥35) awaiting hip and knee operations would be required to attain a BMI below 35, or to lose 5% of their weight (whichever is the lesser weight loss), before planned surgery. In addition, patients would have to have quit smoking at least six weeks before planned surgery.

Yesterday the CCG announced further measures to allow it to prioritise essential services. It said it was temporarily extending the BMI requirement to routine surgical procedures – but clarified that this would not apply to people needing urgently or immediately necessary surgery, such as cancer surgery, nor to patients with a date for surgery. It also said it was extending the quit-smoking requirement to eight weeks before planned surgery. However, it confirmed that “at this time” it would not be restricting in-vitro fertilisation or caesarean sections on medical grounds.

The CCG also agreed temporary changes to: its choice of drugs to treat wet age-related macular degeneration; shockwave therapy for tendon problems and bursitis; restrictions on certain types of shoulder surgery; restrictions on removal of earwax in hospitals; treating cataracts in each eye separately; and restrictions on additional hearing aids. It said it expects to announce further measures “in due course”.

NEW Devon CCG chair Dr Tim Burke said: “All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.

“Clinicians have carefully reviewed a number of measures, taking into account the impacts of their temporary withdrawal to decide which we will implement.

“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case.”

The CCG said last year it returned a £14.5m deficit, and had originally predicted the same this year – but it had “gradually lost confidence” in meeting this, as demand for services is beyond what it can afford.

Dr Burke said: “The services we are temporarily restricting were chosen for a number of reasons … We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them. If they are able to do this it will also have long-term health benefits for them.

“We are committed to being open about what we are considering and how the decisions are being made. We are publishing our decisions and producing information for the patients affected about the available treatment options for them.”

But he said: “The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that.”

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