Revealed: New restrictions on tests as long waits mount

The latest expansion of the evidence-based interventions programmme recommends that 31 procedures should be restricted to only certain types of patients.

Proposals included in the consultation document include limiting the number of colonoscopies and endoscopies to those deemed at high risk of certain conditions, as well as limiting X-rays for frozen shoulders, MRI scans for arthritic hips and some chest X-rays.

Other advised changes include restricting surgery for slipped disks, groin hernias, and knee pain, which it says can be better dealt with through “primary care management” such as weight-loss, painkillers, physiotherapy and psychological therapy.

The programme, which was under way before the covid-19 crisis, is overseen by NHS Clinical Commissioners, the Academy of Medical Royal Colleges, the National Institute for Health and Care Excellence, and NHS England and NHS Improvement.

It follows on from last year’s agreement to stop performing 17 other procedures except in exceptional circumstances.

The consultation document said: “We believe that the impact of covid-19 on the NHS has reinforced the importance of this work. The necessary pause in elective care work to deal with covid-19 pressures has resulted in an increased waiting list.

“As treatments are rescheduled, it is critical that clinicians’ time is freed from providing inappropriate care to focus on providing effective care to people who need it.”

Of the 31 treatments, the paper says there are 13 where there is sufficiently robust data to set a “reduction opportunity” of around 350,000 spells of activity, which is an average of 40 per cent. Some blood testing for heart attacks patients is included in this list, along with endoscopies as a first-line for investigation of suspected gastrointestinal disease.

For the other 18 procedures, the paper said there is not sufficient data to propose a reduction target. This list includes colonoscopies, appendectomies, and imaging for shoulder pain.

Only two treatments, a treadmill ECG test for heart disease and the use of helmets to reshape flat heads in babies, are listed as not to be routinely commissioned by CCGs unless a successful individual funding request is made.

See the consultation document for the full proposals and list of procedures.

The consultation is being supported by the Academy of Medical Royal Colleges but has been drafted by an independent Expert Advisory Committee. The consultation closes on 21 August 2020.

Genevieve Edwards, chief executive of Bowel Cancer UK, said: “Colonoscopies are key to providing a definitive bowel cancer diagnosis, and we would be very concerned if medical professionals were to be steered away from performing them for people displaying symptoms of the disease.

“However, colonoscopies are rarely the first line of investigation for bowel cancer patients, and are likely to follow other non-invasive tests and procedures which have highlighted potential problems.”