Intended for healthcare professionals

Letters Knee and hip surgery refusals

Rationing policy will do far more harm than good

BMJ 2018; 362 doi: (Published 10 September 2018) Cite this as: BMJ 2018;362:k3831
  1. Nick Mann, general practitioner
  1. London E9 7TA, UK
  1. drnickmann{at}

NHS England’s list of restricted procedures normalises denying patients effective treatments.1 Shifting between pretexts of “clinically obsolete” and “too expensive,” it is the antithesis of a sensible, pragmatic response to planning provision for the population in an artificially constrained budget. Clinical commissioning groups’ rationing of hip and knee surgery—effective and cost effective procedures—alongside redundant or cosmetic procedures, creates a …

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