Royal College of Surgeons Opposed to Knee and Hip Plan

The Royal College of Surgeons has condemned the plans of three clinical commissioning groups intended to reduce the eligibility of patients to knee and hip replacement operations.

Redditch and Bromsgrove, South Worcestershire, and Wyre Forest clinical commissioning groups intend to save £2 million annually by altering the way that their scoring system for hip and knee replacement surgery operates.

It is believed that this will result in the eligibility being reduced by approximately 15%, potentially affecting hundreds of patients in the region.

But the Royal College of Surgeons has strongly opposed the scheme, with a spokesman outlining the position of the authoritative organisation.

“Oxford scoring systems were designed to measure patient outcomes and should not be used to create barriers to care. Such criteria are in explicit contravention of NICE and surgical commissioning guidance, and have no clinical justification in being applied to a general population to determine who gets NHS treatment.”

Oxford scores are patient reported outcome measures designed to assess the level of pain and functionality that patients experience following hip and knee replacement surgery.

In a board paper, published on 23rd January, Redditch and Bromsgrove CCG discussed its new position on the issue.

“Utilising the Right Care packs provided to CCGs, the data suggests there is an opportunity to reduce expenditure on hip and knee replacement surgery by circa £2,123,420 per annum. The revised musculoskeletal commissioning policy proposes a reduction in the Oxford hip and knee score from 30 to 25, focusing more on the severe to upper end of moderate. Further refinements to the policy include a BMI of 35 with a requirement to reduce weight by 10 per cent.”

The document went on to explain the benefits for NHS operations in the region.

“Around 10 per cent of activity is undertaken in patients with hip and knee scores [greater than or equal to] 30. A reduction of [hip and knee scores] to [less than] 25 will achieve a 12 per cent and 19 per cent decrease in patients eligible for hip and knee surgery respectively.”

The document concludes that reducing the eligibility score to 225 or less would result in over 350 less surgeries annually, saving approximately £2.1 million every year.

Yet there is strong opposition to the scheme, despite the undoubted financial challenges faced by CCGs.

The Royal College of Surgeons concludes that “this policy is the latest demonstration of how NHS financial pressures are directly affecting patients.”

Responding to criticism, a spokeswoman from Redditch and Bromsgrove CCG stated that preparations have been conducted diligently, and the consequences of this policy had been properly considered.

“The CCG has reviewed the criteria for those patients requiring hip or knee replacement surgery. The Oxford scoring system is a guidance for clinicians and they recognise that many patients will benefit from physiotherapy and weight loss before considering surgery. If a patient feels that they require this surgery but do not meet these criteria, there is a clear appeals system via individual funding requests whereby the effects can be considered upon the patient and the decision made regarding eligibility for funding.”


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