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

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.