FINANCE: A clinical commissioning group will introduce clinical thresholds for surgery and significantly restrict access to services to cope with its ‘financially distressed position’.

North East Essex CCG will bring in thresholds for non-urgent elective surgery on the basis of whether patients smoke or are overweight.

Smokers will be referred to a smoking cessations service, while overweight or obese patients would be “strongly encouraged” to lose weight. “Failure to attend smoking cessation or weight loss programmes may have an impact on whether individuals could undergo their procedure,” the CCG said in a report for a board meeting yesterday.

Cardiac surgery

The CCG will introduce clinical thresholds for non-urgent elective surgery

The CCG will also no longer fund IVF, vasectomy and female sterilisation except “in cases of complex health needs”.

In October, neighbouring Mid Essex CCG approved plans to severely restrict access to specialist fertility services to “exceptional circumstances”.

It will restrict “any qualified provider” access to community spinal therapy services, and the prescription of gluten free food will only be available to young people, pregnant women and breastfeeding mothers, as these products are now “freely available in shops”.

The decisions are part of the CCG’s service restriction plan for 2015-16, which was approved at the meeting.

The CCG paper said it had “resisted cuts and rationalisation of services until now”, but it needed to take a “higher degree of focus” in reviewing the services it funds in its annual commissioning cycle, “owing to the financially distressed position [the CCG] finds itself in”.  

The group has to manage £22m recurrent funding in 2015-16 “whilst demand continues to outstrip currently commissioned and affordably resources”, the report said.

It added that the financial challenge “is predicted to be the same in 2016-17 and 2017-18”.

Restrictions to vasectomy, gluten free products and AQP spinal services will be implemented with immediate effect. The remaining restrictions will be implemented after services have been “worked up” or “examined further”.

The CCG has said it will “adopt a flexible approach” and will “reconsider or adapt the implementation of these changes” if its financial position changes.

CCG acting chief officer Samantha Hepplewhite told HSJ: “We have already made £35m in savings over the past three years by trying to be more efficient in the way we buy care… but unfortunately this is no longer enough.

“We now have to look at restricting access to some services where evidence suggests that the overall benefits to our population are small.

“We have no choice other than to stay within budget, and if we do not implement these decisions then we would have to select other services to restrict.”

The CCG flagged up the “possible need for these sorts of decisions” in a public consultation exercise last year. The local population “understood the dilemma that we faced”, Ms Hepplewhite said. 

In HSJ’s latest CCG barometer, more than a third of groups said they were considering introducing limits on access or eligibility for services this year amid financial pressures.