More than a third of clinical commissioning groups are considering introducing limits on access or eligibility for services this year amid huge financial pressures, the latest HSJ survey of CCG leaders suggests.

The latest barometer questionnaire asked whether their organisations were considering new limits on services during 2015-16 for financial reasons. Thirty-nine per cent of respondents said yes, 57 per cent said no and 4 per cent did not know.

Asked for examples of where they were considering introducing new curbs, responses included limiting IVF services or stopping them altogether.

Others included limiting access to procedures based on aspects of a person’s health, for example whether they smoke or are obese, which can affect outcomes. One CCG leader said they might consider restrictions on “a whole range of current community services”.

Respondents also identified measures such as extending limits on “procedures of limited effectiveness”, introducing clinical thresholds of need for some operations, and requiring prior commissioner approval for more operations.


Another idea under consideration was discharging some patients from podiatry services.

The findings come as financial pressure grows on CCGs, although the sector remains in a significantly better position than NHS providers.

More than one in four respondents to the barometer survey said their organisation was either unlikely or very unlikely to financially balance or record a surplus at the end of 2015-16, while 14 per cent were undecided.

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Some commissioners are considering introducing clinical thresholds of need for some operations

Dudley CCG chief officer Paul Maubach told HSJ: “When [commissioners are] under significant financial pressure, the risk is always that you make cuts in services, [which is] sometimes easier to do than a redesign of a service.”

He said there was a risk that CCGs “under financial pressure and [with] limited financial resources won’t have the capacity to do redesign”.

Bradford City and Bradford Districts CCGs chief officer Helen Hirst said service access and eligibility had been a “recurrent theme” and a “perennial conversation that commissioners have”.