Nearly a third of clinical commissioning groups have implemented or are considering restrictions to services this year, HSJ research reveals.

  • Almost a third of CCGs have implemented or are considering restricting access to services
  • CCGs are making joint decisions in their region on procedures of “limited clinical value”
  • Commissioner have brought in limits amid financial pressures

HSJ sent freedom of information requests to all 209 CCGs asking whether they had introduced or planned limits to access or eligibility for services during 2015-16 for financial, efficiency or value reasons.

Thirty-four CCGs said they had introduced or approved restrictions, out of the 188 groups that responded. Thirty-three said they were considering changes or that their plans were under review.

Our research found that neighbouring CCGs have tended to make joint or similar decisions, particularly on procedures deemed to be of “limited clinical value”.

All CCGs across Nottinghamshire, except Bassetlaw, have agreed to a joint commissioning policy on such procedures.

A policy document said: “This assessment of need is made across the whole population and, wherever possible, on the basis of best evidence about what works.

“We also aim to do this in a way that is fair, so that different people with equal need have equal opportunity to access services.”

The document lists a raft of treatments, including surgery for sleep apnoea and hysterectomy for heavy menstrual bleeding, which the groups say “can only be paid for by the local NHS in certain restricted circumstances”.

Amanda Doyle

Local NHS leaders must have the flexibility to review their clinical pathways, Amanda Doyle said

It also lists a number of mostly cosmetic treatments that “don’t work well enough to justify any use within the local NHS”, such as fat grafts; hair depilation; earlobe repair; and chin, cheek or collagen implants.

Seven CCGs across Birmingham, the Black Country and Solihull are also developing a single set of agreed clinical commissioning policies.

A spokesman for the CCGs said: “This is to ensure equal access for patients to NHS services across the area. The work is ongoing and no [final] decisions have been made.”

In the South West, Bristol and South Gloucestershire, CCGs agreed in June to new policies to restrict access to acupuncture, adenoidectomy and post-operative physiotherapy, which will be implemented once local trusts agree to the contract changes.

Basildon and Brentwood CCG in Essex is considering restricting access to specialist fertility services, in line with the existing policies of Mid Essex and North East Essex CCGs.

North East Essex also plans to bring in thresholds for non-urgent elective surgery on the basis of whether patients smoke or are overweight, while Mid Essex is considering changes to continuing healthcare.

Decisions to ration services have faced opposition. In March, North Staffordshire became the first CCG in the country to restrict access to NHS funded hearing aids, which it said would save £200,000 in the first full year. The charity Action on Hearing Loss warned it was the “thin end of the wedge” for wider charging for NHS services by CCGs, but the plans were backed by NHS England, which said the group had followed “proper process” and made an evidence based decision.

Amanda Doyle, co-chair of NHS Clinical Commissioners, said: “Ensuring patients get the best possible care against a backdrop of increasingly squeezed finances is one of the biggest issues CCGs face, and they have a statutory responsibility to commission cost effective healthcare for their patients and local populations. The NHS does not have unlimited resources and it is right that clinical commissioners review their services to ensure they are providing the best possible care, balancing demand with supply for the benefit of their patients and local populations.

“If neighbouring CCGs are aligning plans then it is because it is right for that area - for example, it might make sense to work across an acute trust footprint that covers more than one CCG area.”

She added: “Clinicians and local NHS leaders must be given the flexibility to look across their clinical pathways to review their services, and be trusted to do the job they have been tasked to… without being accused of wilfully reducing access to services.”

More than a third of commissioners responding to HSJ’s CCG barometer survey in April said they were considering introducing limits to services this year, amid huge financial pressures.