East Anglian health trusts say thresholds for care are based on clinical grounds not cost

PUBLISHED: 18:59 19 June 2012

A hospital department.

A hospital department.

Archant Norfolk Photographic © 2009

Health trusts in Norfolk and Suffolk are among those that have restrictions in access to non-urgent procedures - but bosses say the thresholds are based on clinical grounds and not cost.

Health Minister Simon Burns has said rationing treatment on grounds of cost is “totally unacceptable” and decisions as to whether and when to treat patients should be on clinical grounds alone.

Mr Burns’ remarks were made after a freedom of information request lodged by GP magazine showed that 90pc of primary care trusts (PCTs) were restricting procedures including hip, knee and cataract operations, weight-loss surgery and tonsillectomies.

The medical magazine said information released by 101 of the 151 primary care trusts showed nine in 10 had procedures to restrict GP referrals for procedures thought to be non-urgent or of low clinical value.

Limits on cataract surgery have been ordered in two-thirds of trusts, while six in 10 restricted weight-loss surgery and hip and knee operations.

NHS Norfolk and Waveney has guidelines for thresholds for GP referral, and for some non-urgent procedures GPs have to get “prior approval” from the PCT, with patients expected to certain criteria.

The Eastern Daily Press has previously reported on NHS Norfolk’s ongoing reviews and additions to its own “prior approval” list of non-routine treatments.

Since 2007 NHS Norfolk has been identifying, with the help of clinicians, treatments which need to be approved by it beforehand.

Each treatment has strict thresholds for what will and will not be funded. The PCT says the changes are not about saving money but set out clear guidance for clinicians on when treatment is appropriate.

Previously, the non-routine treatments would have been automatically carried out after referral by a GP and the primary care trust argues that by implementing thresholds it standardises care across the area.

The latest procedures to be added earlier this year include surgery to remove benign tumours called lipomas, procedures for bunions and several surgical procedures and treatment for eyelids, such as for cysts, drooping eyelids or excess skin.

Already on the prior approval list are procedures such as hip replacements, bariatric surgery, varicose veins, tonsillectomies and breast reductions.

If a certain patient does not meet the eligibility thresholds for the procedure, GPs can still submit an Individual Funding Request to ask for that patient’s exceptional circumstances to be looked at and considered for the procedure or operation.

Dr Alistair Lipp, medical director NHS Norfolk and Waveney, said: “We clearly don’t want to spend money treating things which don’t need treating, so the decision for when it’s appropriate to treat is based on the clinical decision.”

NHS Suffolk has a similar list of procedures, for which there are thresholds, and which it calls clinical prioritisation policies.

Dr Andrew Hassan, NHS Suffolk’s medical director, said: “NHS Suffolk’s clinical prioritisation policies ensure that patients receive the most appropriate treatment for their needs, which is supported by evidence of clinical effectiveness.

“These policies also ensure that there is equitable access to treatment and promote consistency of care. NHS Suffolk does not put up unnecessary barriers to treatment and is transparent in its policy making, with its policies reviewed regularly to ensure patients can access up-to-date services that work, are beneficial and offer value for money both for the health system and tax payers.”

More information about procedures, current thresholds and prioritisation policies is available at, or

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