A Midlands primary care trust has halted funding for a raft of routine procedures, including cataract removal and hip replacements, in order to remain financially viable over the winter.
Until now PCTs have largely made small scale attempts to cut back on actual services offered, for example NHS Warrington ceased funding most IVF treatment last month.
However, NHS Warwickshire has written to provider organisation chief executives outlining two lists of non life threatening procedures that it says will either no longer be funded permanently or temporarily – following discussion with its clinical executive committee.
The list of nine permanently banned procedures includes acupuncture, epidurals for back pain and oral vaccination against hay fever. The second list – of more than 20 procedures halted until the end of the financial year – includes new IVF treatment cycles, all routine elective orthopaedic operations, and secondary care back pain management.
All of the procedures in this second list can be accelerated, however, if the patient’s GP concludes the treatment should go ahead immediately, and this view is supported after review by a second GP, who has a specialist in the relevant clinical area.
The PCT has also banned consultants from referring cases to each other from 1 November, as part of moves to reduce the number of assessments and reviews taking place in secondary care that could otherwise be done in primary care. The only exceptions are cancer referrals and accident and emergency to fracture clinics referrals.
In his letter NHS Warwickshire chief executive Paul Jennings said there had been a “continual and significant increases in the demand” for acute services in the area, which had not been slowed by measures such as extending the range of services available in the community.
He said: “With winter now fast approaching we do not see any indications that this situation will improve in the short term.
“We must take urgent and immediate action to ensure that the health system in Warwickshire is sustainable both financially and operationally.”
Mr Jennings also expressed disappointment that a previous policy of defining 14 procedures as low priority and allowing providers to decide which were “sufficiently exceptional” to go ahead had failed to have sufficient impact, leading to the stricter measures.
He said: “Activity in these procedures has continued to grow overall despite these policies and so, we are no longer confident that the criteria laid out within those policies are being rigorously applied. We are therefore changing this process.”
Mr Jennings acknowledged to chief executives that the measures were “not ideal” and would be difficult to implement.
“However, I am sure that you will agree with me that the current situation cannot continue,” he said.
A spokesman for NHS Warwickshire claimed the move had the support of the majority of local GPs.