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Birmingham CCGs’ proposals could prevent patients receiving necessary clinical treatment

05 Apr 2016

The Royal College of Surgeons (RCS) has today written to six Birmingham region Clinical Commission Group (CCG) chairs expressing concern with proposals that would restrict access to surgery. The CCGs are planning to place thresholds on several planned surgical procedures, including hip and knee replacements and hernia repair. The open letter published today (5 April) responds to a recent consultation on what the CCGs refer to as ‘Procedures of Lower Clinical Value’ (PLCV).

Between them, the six CCGs are responsible for the planning and commissioning of health care services for more than 2 million patients in the region. The letter voices particular concern that the CCGs’ consultation document makes extensive reference to clinical guidance published by the RCS and surgical specialty associations (SSAs) but either ignores or cites it out of context. Some policies are presented as if they are supported by clinically-evidenced guidance but in fact contravene this guidance.

In the letter Mr Paul O’Flynn, Royal College of Surgeons Council Member and Lead for Commissioning, says: “The Royal College of Surgeons (RCS) believes patients’ access to treatment must be based on clinical assessment and evidence-based practice.”

He goes on to say: “We strongly urge you to reconsider your position [on the points of concern above]. The RCS has produced clear guidance, accredited by NICE, and this should be fully taken into account in CCGs’ commissioning policies. In this case, our guidance has been misrepresented and incorrectly referenced in many places.”

The RCS response to the CCGs proposals include concerns about:

  • A policy of referring patients to hip and knee surgery only if their BMI is below 35. Such a policy could impact a number of people given the average prevalence of severe knee osteoarthritis is 6.8%  across the population covered by the six CCGs.
  • A policy that will only fund surgery for irreducible or partly reducible inguinal hernias, or those that cause pain that limits daily activity, or are strangulated or obstructed. This goes against current RCS/SSA guidance.
  • A policy to document five or more episodes of glue ear in a child before being referred for grommets treatment which is not evidenced in RCS/SSA or NICE guidance.
  • A policy of only referring patients for the adenoidectomy if undertaken at the same time as grommets or tonsillectomy.
  • A policy of only surgically treating more advanced cases of varicose veins. Varicose veins that are not treated at an earlier stage are likely to deteriorate and require later surgery.
  • Misrepresentation of RCS guidance on back pain treatment.

The full open letter is open letter published today.

Clinical Commissioning Groups (CCGs) across Birmingham, Solihull and the Black Country ran a consultation regarding PLVC which closed on Monday 14 March 2016.

Notes to editors

The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance surgical standards and improve patient care.

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