GUIDANCE for NHS treatment needs to be set at a local level to best meet patient needs, according to a leading Hampshire GP.
Dr Barbara Rushton is the clinical chairman of the Southern Eastern Hampshire (SEH) Clinical Commissioning Group (CCG).
Recently it turned down a 66-year-old patient from Denmead, named only as Maggie, for a replacement hip operation because her Body Mass Index (BMI) is 35.5, meaning she is rated as obese.
The CCG locally has set a limit of 35. But in Dorset and North Hampshire CCGs, there is no BMI-limit cap.
But Dr Rushton said guidance needs to be set at a local level, rather than a blanket national policy, to suit patient needs. She said: ‘For hip replacement surgery there are sound, clinical reasons why a patient’s weight must be taken into consideration.
‘Firstly, someone who is significantly overweight is at far greater risk of suffering serious complications as a result of the surgery itself, and secondly the chances of the patient gaining any real benefit from the operation are much reduced.
‘Our guidelines were agreed by clinical leaders, not financial staff, and it is important to stress that they are guidelines, not a blanket ban.
‘If a surgeon feels a patient with obesity should still undergo joint replacement surgery, they can make an individual case on a prior approval basis.’
In 2013/14 there were 45 such applications in the area, of which 32 were approved.
Maggie said: ‘My operation had been cancelled twice because I was ill, and when it was scheduled a third time, my BMI went to 35.5.
‘I find it difficult to exercise because of the problems with my hip. I was told to join Weight Watchers or Slimming World, but as a pensioner this is expensive.’
Not all CCGs set these limits for procedures.
Dr Rushton said: ‘The NHS in a local area makes decisions about access to healthcare and those decisions – rightly – will differ from place to place to reflect the differing characteristics of each population.
‘However, the most important single factor in any decision is always the specific needs of the individual patient.
‘In SEH, F&G, and Portsmouth we have set our own eligibility criteria for some clinical areas.’