Pan-London commissioning plans could restrict access to common procedures, warns BMA

Access to common elective procedures such as hip and knee replacements could be restricted in the capital if new policies set out as part of the ‘London Choosing Wisely Programme’ go ahead, the BMA has warned.

Clinicians in the capital have raised concerns that the proposals, which aim to develop pan-London policies for NHS referral in eight treatment areas, are being rushed through after they were given just ten days to provide feedback.

The BMA London Regional Council said the limited consultation period meant there would be no meaningful clinical engagement with the profession about the proposed changes, which it claims could introduce barriers to treatment.

The plans follow a clinically-led review for the Healthy London Partnership, a consortium of NHS, local authorities and other public bodies in the capital, and aim to change referral criteria for eight procedures: benign skin lesions; hip arthroplasty; knee arthroplasty; knee arthroscopy; back pain; varicose vein; subacromial shoulder pain and cataract surgery.

The proposals recommend that primary hip arthroplasty, for example, should only be performed if the patient has osteoarthritis with joint symptoms which ‘have a substantial impact on quality of life’ and do not respond to non-surgical treatment together with radiological evidence of degenerative disease.

A BMA spokesperson told HM: ‘In current guidelines, there is no criteria; patients are referred for procedures because a doctor, following NICE guidelines, thinks it’s the best clinical action to take. However, these policies will create bureaucratic barriers for doctors to prove their referrals meet these new criteria, designed to make services more cost-effective, meaning some patients could have their treatment delayed or denied altogether.’

According to BMA London regional council chair Dr Gary Marlowe, the brief consultation window does not allow for the necessary engagement and clinical input to ensure the best possible outcomes for patients.

‘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,’ he said. ‘This is again another example of how inadequate funding is impacting patient care and depriving patients of treatment is not a long-term sustainable solution.’