Dupuytren’s contracture is a condition that causes fingers to bend towards the palm. Named after the French surgeon who first described the condition in 1834, it mainly affects men - a reported one in five men aged over 60 - and is most prevalent among people of northern European descent.
Surgery is the recognised treatment: a simple day case procedure to remove tension on the finger in question and restore everyday functions like buttoning shirts or counting coins. About 12,000 such operations are performed in the UK each year. The payment by results tariff, assuming no complications, is £719 plus the relevant market forces factor.
Depending where you live, however, surgery for Dupuytren’s is becoming harder to obtain on the NHS. As one of 34 procedures selected by NHS Croydon for potential savings, and included on the so-called “Croydon list”, access to Dupuytren’s procedures is now being curtailed by other primary care trusts attempting to squeeze elective surgery costs.
However, the criteria being applied by individual PCTs vary. NHS Manchester’s recommendation (November 2010) is that surgery “is not available for patients that do not have severe symptoms”, interpreted as “patients with a metacarpophalangeal joint contracture of 30 degrees or more”.
Travel south to NHS Dudley, however, and the criteria (October 2010) are functional - “interferes adversely with the patient’s daily living” - and the easier to measure “cannot get their hand flat on a table”. NHS Dudley also accepts that surgery shouldn’t be “so late that patients end up with a fixed deformity in their hand”.
How this fits with patient choice is far from clear, unless the choice in question is Hobson’s.
Last week the Cooperation and Competition Panel undertook to explore “whether the restrictions being exercised by PCTs have any potential benefits - for example, controlling expenditure - that outweigh the costs… of reduced choice and competition”.
A more apposite question is perhaps how patients with a “Croydon list” condition - the list also includes, for instance, cataracts that cover less than half the eye, and potential hip and knee replacements that don’t yet hurt enough - might in future choose their GP consortium.