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Nearly 1700 requests for knee and hip surgery were rejected in England last year

BMJ 2018; 362 doi: (Published 18 July 2018) Cite this as: BMJ 2018;362:k3002
  1. Gareth Iacobucci
  1. The BMJ

Increasing numbers of patients seeking knee or hip surgery are finding they can’t have operations on the NHS, an investigation by The BMJ has found.

In 2017-18 a total of 1675 exceptional funding requests (1188 for knee surgery and 487 for hip surgery) were turned down by clinical commissioning groups (CCGs), show the data obtained under a freedom of information request. This was a 45% increase from 2016-17, when 1155 requests were rejected (766 for knee and 389 for hip surgery).

Exceptional funding requests have been used since the 2000s to limit cosmetic procedures and fertility treatment. But as NHS finances have been squeezed, some CCG areas have started to use them for a wider range of treatments. GPs refer patients to specialists as normal, but there is no guarantee that if they recommend a treatment it will be funded. Instead the patient’s GP then has to submit an exceptional funding request to the CCG, and a panel decides whether to fund it.

As The BMJ first revealed last year,12 these types of requests have surged in recent years as CCGs try to keep down costs.

The BMJ’s latest analysis shows stark variation across the country in how CCGs are applying restrictions on surgery (box 1). For example, Buckinghamshire CCG had 1298 exceptional funding requests for knee surgery last year and rejected 18% (fig 1), while Doncaster had far fewer requests through this route (24) but rejected all but one.

Box 1

How access to hip and knee surgery varies across England

CCGs with highest numbers of exceptional funding or prior approval rejections in 2017-18

Knee surgery

  1. Buckinghamshire: 230 rejections, from 1298 requests (18%)

  2. East and North Hertfordshire: 198, from 1575 (13%)

  3. Wiltshire: 62, from 194 (32%)

  4. Basildon and Brentwood: 52, from 280 (19%)

  5. East Berkshire: 46, from 280 (16%)

Hip surgery

  1. Basildon and Brentwood: 99, from 216 (46%)

  2. Buckinghamshire: 91, from 907 (10%)

  3. East and …

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