Morbidly obese patients in most of Devon will have to lose up to 5 per cent of their weight before undergoing any elective surgery, under plans confirmed by the country’s largest clinical commissioning group.

Patients living in the area covered by Northern, Eastern and Western Devon CCG will also have to show they have stopped smoking for eight weeks before they can undergo routine procedures.

These stringent access policies for routine surgery - announced this week - are in addition to restrictions announced on hip and knee replacements for obese patients and smokers which have already been introduced.

CCG chair Tim Burke said the measures were temporary and did not relate to procedures that “must be done as an emergency or to save lives”.

“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case,” he said.

The measures have been agreed by a panel of clinicians on the CCG’s governing body in a bid to help the group find £26m of in-year savings and avoid finishing the year with a cumulative deficit of £30m.

As reported by HSJ last month, 24 proposals had been put forward for consideration.

They have also agreed the use of the unlicensed drug Avastin for the treatment of wet age related macular degeneration, rather than Lucentis, the drug licensed for treatment of the condition but which is up to 10 times the price.

The other changes agreed were:

  • stopping shockwave therapy for tendon problems and bursitis completely;
  • restrictions on certain types of shoulder surgery;
  • restrictions on removal of earwax in hospitals;
  • treating cataracts in each eye separately; and
  • restrictions on additional hearing aids.

A further round of cost saving measures is expected to be announced in the near future.

The list of 24 will continue to be considered, with the exception of its proposal to restrict elective caesarean without medical grounds.

Woman smoking

The CCG decided to restrict surgery to patients who smoked because evidence suggests clinical effectiveness is improved if they stopped

The CCG has also decided against suspending IVF treatment.

It already only offers women one cycle compared to a national guidance of three.

CCG chief officer Rebecca Harriott told HSJ all of the procedures had been through the same process.

This considers clinical effectiveness as well as the impact of any restrictions on quality of services and equality.

She said that some measures had proved “easier to assess than others”.

The decision not to consider restrictions on caesareans was taken as there was no cost benefit in making the cut, while IVF survived this time as it scored highly on patient experience.

Meanwhile, the decision to restrict surgery for patients who are morbidly obese or who smoke was taken as there was a lot of evidence that clinical effectiveness was improved if people stopped smoking or lost weight.

Asked whether the CCG was concerned about clinicians failing to comply with the policy to prescribe Avastin, she said: “Our commissioning policy is to commission Avastin; given that they [doctors] prescribe Avastin privately we would hope it won’t be a problem.”

The measures have been opposed by the Royal College of Surgeons and Labour MP for Exeter Ben Bradshaw has secured a debate in the House of Commons next Thursday on the rationing of services in Devon.

In a letter sent to Dr Burke this morning RCS president Clare Marx urged the CCG to reconsider its position.

It said: “We agree that patients with a high BMI should attempt to lose weight, and smokers should stop smoking. However… clinical guidance is clear that such criteria should not alone create a total barier to surgery.”