England General practitioner

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Plans to curb access to care rushed through

Organ transplant

London doctors have raised concerns about plans to curb patient access to commonplace surgical treatments – after being given just two weeks to respond to a series of consultations.

The plans are being drawn up by London Choosing Wisely following a review of clinical evidence for the Healthy London Partnership, a consortium of NHS, local authorities and other public bodies in the capital.

It aims to change the referral criteria for eight procedures, such as hip and knee replacements, treatments for back pain, and cataract surgery.

The review has pledged to ‘engage with clinicians across the NHS in London’, is led by senior doctors, and any changes will be signed of by the capital’s 32 CCGs (clinical commissioning groups).

But doctors outside of its various review groups are objecting because they have been given just 10 days to respond to proposals that could add layers of bureaucracy and force patients to wait longer for treatment.

BMA London regional council chair Gary Marlowe said the ‘brief window’ of consultation would not allow doctors to provide clinical input to ensure the best outcomes for patients.

‘Worryingly it doesn’t seem there has been any meaningful attempt to liaise with patients either,' he said.

‘It would be worrying if the short timeframe we’ve been given to give our input on changes to health services in the capital was an attempt to push through these unpopular restrictions which will have a long-lasting impact on patients.

‘People expecting key interventions such as hip surgery will be adversely affected, and it’s unfair that they could be denied treatment ordinarily available elsewhere.

‘Given the current pressures on GP practices, the additional workload and demand, particularly in GP referrals, these changes could add an additional layer of bureaucracy at a time when resources are in short supply.’

Tower Hamlets GP Jackie Applebee said she was very concerned about the manner in which this 'consultation' was being run.

‘As with sustainability and transformation plans, this process looks like another cover for rationing,’ she said.

‘GPs don’t need yet more bureaucratic hurdles to jump through and yet more forms to fill in. If London Choosing Wisely really wants to iron out variations in referrals they should make treatment available to the highest common denominator not restrict it to the lowest.’

A spokesperson for Healthy London Partnership said there was ‘variation across London in local policy for the eight procedures’.

‘The development of a London-wide policy for each treatment area will harmonise and build upon existing local CCG policies and help support a more consistent approach to implementing NICE guidance,’ he added.

The London Choosing Wisely programme was  ‘advisory’, the spokesperson said. ‘The statutory duty for approval of London-wide policies rests with each CCG governing body who will have the opportunity to consult and debate the draft policies further, before making a decision.’ 

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