Patients in need of routine operations that were once provided without question, such as hip replacements and cataract surgery, are having to plead with the NHS to fund their treatments, an investigation has found.
As a result, there has been a surge in the number of special requests made by doctors on behalf of their patients for procedures to be funded.
In 2016/2017, 73,927 such requests were made, of which almost half (48%) were rejected because they were not deemed cost effective or beneficial. That’s almost 50% more than the 50,188 individual funding requests (IFRs) doctors submitted to clinical commissioning groups (CCGs) in 2013-14.
Patients whose requests have been denied now face a choice of either putting up with their pain or paying up to £100,000 to go private.
The situation has arisen as CCGs are having to increasingly ration procedures considered to be low priority in order to meet strict financial targets. Increasingly strict eligibility guidelines are being imposed by managers to limit the number of patients referred for routine procedures.
Using freedom of information requests to obtain data from 192 of England’s CCGs (207 requests were sent in total) the British Medical Journal (BMJ) found that the most common reason for an IFR in 2016 was for surgery to remove unsightly skin, such as skin tags and varicose veins, which doctors submitted on behalf of some 6,079 patients.
The next most common reasons for an IFR last year were: cosmetic and aesthetic surgery (4,426 IFRs), plastic surgery (1,889) and fertility treatment (1,151).
Despite the NHS’s pledge to improve access to mental health care, doctors still had to submit 1,150 IFRs on behalf of patients to get them the care they needed for a number of mental health conditions – making such requests the sixth most common submitted by doctors last year.
In 2016, Wakefield CCG processed 122 IFRs for mental health treatment, such as diagnosis of autism, treatment for attention deficit hyperactivity disorder, psychiatry and counselling. However, just eight were approved.
Nevertheless, a CCG spokeswoman said that patients still received “timely and necessary access” to psychological therapies.
Aylesbury Vale CCG and Chiltern CCG in Buckinghamshire have recently issued guidance stating that all referrals for hip and knee surgery should go through a special funding request process.
The number of IFRs received by CCGs also differs greatly from region to region. For example, the BMJ said that Rushcliffe CCG in Nottingham received no requests last year, while Chiltern CCG processed 3,800.
Southern Derbyshire CCG received 14 requests last year for procedures such as cataract surgery but approved none. In contrast, Stafford and Surrounds CCG received 2,123 requests and approved them all.
Dr Richard Vautrey, acting chairman of the British Medical Association’s GP committee, said: “It’s completely unacceptable that local health bodies are placed in the situation of having to ration care, leading to one patient being able to access a service in their area but another patient who lives in another health area, being unable to access the same service.”
Could you afford to pay up to £100,000 to receive private treatment that the NHS are deeming not financially cost effective or beneficial?
Why put yourselves in this position, people need to be considering the option of providing their own piece of mind by taking out Private Medical Insurance.
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