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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

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

The IFR (Individual Funding Process (also referred to among patients as the 'Invidious Funereal Process')) is not only unfair and unreasonable, it is detrimental to doctors as well as patients.

In 2005 I had difficulty accessing a course of MLD (Manual Lymphatic Drainage) to treat NHS cancer treatment-induced midline lymphoedema, but eventually the PCT (Primary Care Trust) commissioned an intensive course at a hospital trust which usually only treated arm lymphoedema. The course was monitored at beginning and end by a specialist in this field and pronounced 'successful' with an estimated 3 litres of fluid lost.

The benefits of treatment lasted several years, but then the lymphoedema clinic I attended told me they would only be treating new patients in future. I moved to a hospice-based clinic, but found I could no longer obtain any support pantyhose previously supplied by the hospital-based clinic, which would now cost me around £50 each. Also, the clinic could not afford to offer that intensive MLD treatment, so I asked my GP for help. The GP had to apply via the IFR process and the application was denied. Over the last few years my supportive GP has made several similar applications to the CCG but without success and each time I have felt caught up in a Kafkaesque situation.

The CCG did not appear to have any knowledge of what services were available: they suggested I apply to the hospital which only treated arm lymphoedema, but, unlike the PCT, did not commission a course of MLD, so my application was turned down. They suggested I apply to the very hospital clinic I had left (which had decided to treat only new patients). Strangely, I was told an appointment had been arranged at the surgical department of the hospital that only treated arm lymphoedema, which, being inappropriate, had to be cancelled, along with ambulance transport. Finally, the CCG told me to apply to the hospice clinic (where I was already enrolled but which had already stated it could not afford to treat me).

With every IFR application the psychological effects of raised hopes and disappointments combine. Thanks to the IFR, there is no NHS help for an NHS treatment-induced condition. Add to this the effect on a GP's job satisfaction and workload – and the guilt I feel for having added to their burden.

Competing interests: No competing interests

25 July 2018
Mitzi A J Blennerhassett
medical writer/author, bmj patient reviewer
Ryedale, North Yorkshire