Patients are being denied “vital” surgical procedures because clinical commissioning groups are imposing “arbitrary” restrictions on care, leading doctors have warned.

The Royal College of Surgeons said that patients across England are facing a postcode lottery as to whether or not they get some types of treatment.

The college examined patient access to four common surgical procedures across the country and found that a number of CCGs were restricting access contrary to national guidance.

Data was collected from 52 CCGs about their policies on hip replacements, the removal of tonsils, hernia operations and surgical treatment for glue ear - also known as Otitis media with effusion.

The RCS said that three-quarters of these local health bodies do not follow national guidelines for surgery for those in need of a new hip, with 44 per cent requiring patients to be in various degrees of pain or to lose weight before surgery.

Only a quarter (27 per cent) followed guidance from the National Institute for Health and Care Excellence on inguinal hernia repair and 15 per cent said that there must be evidence of a hernia increasing in size, or a history of recurring problems, before a patient can receive treatment, the college found.

It also said that 77 per cent did not follow clinical evidence for the treatment of glue ear and two CCGs had imposed “watchful waiting” periods before patients could receive tonsillectomies - meaning some people could not access treatment for up to a year and a half.

“In the past, some commentators have suggested such arbitrary criteria are motivated by the need to make short-term savings in the NHS,” said the authors of the RCS’s new report Is Access to Surgery a Postcode Lottery?

“While it is impossible to prove categorically that CCGs are imposing arbitrary criteria for financial reasons alone, some CCGs’ policies do not reflect clinically accepted evidence-based guidance so we question how these policies were conceived.

“Our primary concern is that there is no clinical justification for many of the policies discussed in this report.

“The RCS believes that patients’ access to treatment must be based purely on clinical assessment and informed discussion between the clinician and patient. Denying access to treatment can impact on the outcomes of surgery and patient safety, with evidence that patients are less mobile and suffer more pain if operations are delayed or denied.

“In the case of groin hernia repair, delays in operating can lead in rare circumstances to a strangulated hernia, which is a medical emergency.”

Clare Marx, president of the RCS, added: “This report seems to show that local commissioners are imposing arbitrary rules governing access to some routine surgery. The motivation may not be financial but it is clear that some CCGs do not commission services using clinically accepted evidence-based guidance.”

An NHS England spokeswoman said: “We are doing more operations and treating more people than ever - over a million people start treatment with a consultant each month.

“Decisions about what care a patient gets must be taken by clinicians on the basis of what that individual needs.

“NHS England is working to help CCGs to make the right choices around spending by presenting them with useful data which shows how extremely successful operations such as replacements are.”