Morbidly obese patients face restrictions under new Devon cost cutting plan

In a paper due to go before the governing body next week, Northern, Eastern and Western Devon CCG warned its deficit could double to almost £30m by the end of the year without immediate action to implement a raft of money saving initiatives.

Other measures proposed in the document include seeking permission from NHS England for GPs to be released from elements of the GP contract and a clamp down on spend on continuing healthcare packages.

The CCG is currently seeing an increase in continuing healthcare claims of 34 a month compared with a planned five.

Northern, Eastern and Western Devon estimates up to £4.5m could be saved through reviewing decision making thresholds for the claims. It also aims to bring the prices paid for care into line with other areas and potentially bringing assessment of claims back in house. Assessments are currently carried out by community providers.

The publication of the paper follows the CCG’s warning last week that “services would suffer” due to unaffordable rises in demand.

It said over activity at acute trusts, particularly Royal Devon and Exeter and Northern Devon Healthcare Trust, are also putting pressure on the CCG’s bottom line and it hopes to release £3.61m of savings through better contract management.

The paper, entitled Urgent and necessary measures, said: “Without decisive action [the] CCG is heading for over performance against plan of £14.5m, which would result in a cumulative deficit of £43.7m. A deficit of this magnitude will have a significant impact on the CCG.”

The CCG is the largest in the country with a turnover of nearly £1.1 billion.

In February this year Devon was named as one of 11 financially challenged health economies by NHS England, Monitor and the NHS Trust Development Authority.

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At its September meeting the governing body approved plans requiring morbidly obese patients to undergo a weight loss programme before having a hip or knee replacement, in line with guidance from the National Institute for Health and Care Excellence.

However, the latest paper reveals plans to go further and increase the range of procedures that require morbidly obese patients to lose weight.

Patients with a diagnosis of cancer, or undergoing neurology or cardiology procedures would be excluded from the restriction, which it is hoped could save almost £1.4m over a 12 month period.

NEW Devon chief officer Rebecca Harriott told HSJ the CCG had taken legal advice on the implications of this move and was putting together a panel to look at what procedures this could be applied to.

She said that in a private session of next Wednesday’s governing body meeting, its members would be asked to consider an analysis of the priority of a range of non-urgent treatments and agree on which ones should be stopped with “immediate” effect, prior to public consultation.

The paper said this could include procedures such shockwave therapy for tendinopathy and ultrasound guided steroid injections. The CCG has set a target of saving £3.5m through this prioritisation process by the end of March 2015.

The potential of moving away from the quality and outcomes framework and the unplanned admissions and directed enhanced services elements of the GP contract have yet to be identified.

Ms Harriott said the CCG felt it would be “helpful” if GP incentives were aligned with the CCG’s financial recovery plan but the move would not be imposed on practices.