Forum topic: Further chances to discuss proposed restrictions on NHS procedures

The deadline for commenting on controversial proposals to introduce measures to limit access to certain medical procedures in Enfield has been extended until 31 May.  A meeting at the end of March clearly showed the level of public disquiet about what is being planned.  I would recommend anyone concerned about the future of the NHS to attend one of the newly arranged consultation meetings.

The meeting at Community House in Edmonton was attended by ordinary members of the public, but also by many NHS practitioners, who were able to subject the proposals to expert criticism

The consultation goes under the snappy name "Adherence to Evidence-Based Medicines Programme", which roughly translated means "only carrying out medical procedures where there is evidence that they will be of benefit".  Specifically, the proposals relate to a list of procedures which the Enfield Clinical Commissioning Group (CCG) believes are sometimes being carried out on patients when it would have been better if they had not been.  The main reasons being that they may present an unnecessary risk to the patient (general anaesthetics are always risky to some extent), there are less drastic alternatives (eg physiotherapy for knee pain) or there is simply little or no evidence that they work (eg homeopathy).

One might expect that NHS doctors would automatically take account of the best advice on these questions, as provided by bodies such as the National Institute for Clinical Excellence, the Royal College of Surgeons, the Royal College of Paediatrics and others. One might expect that when a GP refers a patient to a hospital specialist, the specialist when examining the patient will use this guidance and his own expertise to judge whether or not to operate. One might expect this, and personally I do believe this to be true in the vast majority of cases.

However, it is the contention of Dr Jahan Mahmoodi, Clinical Director of the Enfield Clinical Commissioning Group, that "a surgeon will always operate" and that when a GP refers a patient to a hospital for a procedure "the surgeon will happily do it" (wording that I noted down at the meeting).  The reason being that the hospital's finances gain, as they are paid by the CCG for each procedure they carry out.  In fact, Dr Mahmoodi went so far as to talk about "hospitals overcharging".

To prevent this, the CCG has drawn up a list of more stringent conditions required before it will allow a GP to refer a patient.  The GP's referral would first be considered by a referral panel, who decide whether to pass it to the hospital without even seeing the patient.  They would use criteria such as an evaluation of the level of pain suffered, even though the Royal Colleges do not endorse this.  (This procedure is already in use by Enfield CCG for a list of procedures, such as lower back pain.)

There was considerable opposition voiced at the meeting, in particular to the proposal to limit prescription of hearing aids to people with mild hearing loss.  Dr Mahmoodi claimed that people with mild hearing loss often chose not to use their expensive hearing aids.  This was hotly contested by both patients and audiologists in the room, who reiterated the importance of getting used to hearing aids sooner rather than later.  (At the start of the meeting, Dr Mahmoodi had implied that an audiologist at the meeting was not an impartial person, but represented "industry".)

The Medical Director referred repeatedly to clinical decision making, but made no bones about the fact that the CCG is in "special measures" because it has built up a large "deficit".  Could this by any chance be the result of the very low amount of funding per head that Enfield receives compared with many other boroughs rather than being caused by reckless spending on hearing aids and vasectomies?  Go along to one of the meetings to draw your own conclusions, and make sure you respond to the consultation.