Please say ‘no’ right now to withdrawal of routine NHS funding to 31 tests, treatments and medical procedures!

After ending routine NHS funding for 17 ‘planned’ operations in 2019, NHS England/Improvement now intend to extend this withdrawal of funding to 31 diagnostic tests, treatments and medical procedures.

Consultation on Wave 2 of the so-called Evidence Based Interventions Policy ends on Monday August 24th.

(Update 29.8.2020) This is the Patients’ Association response (downloadable, below). They are not impressed.

patients_association_response_to_the_consultation_on_evidence_based_interventions_2020Download

Sorry for short notice, but please will you respond to the consultation now?

If you are not in favour of further financial restrictions to GPs’ ability to decide with us – their patients – what is the most appropriate treatment for a wide variety of ailments, you are welcome to copy/ amend the email below and send it to EBI@aomrc.org.uk with the subject heading “Evidence Based Interventions-Wave Two consultation”.

This is NOT evidence-based medicine

The “engagement” document justifies stopping routine funding for these procedures on the grounds that this will avoid unnecessary harm to patients and waste of resources.

Of course doctors are already very aware of these issues – they are not new (“I will do no harm or injustice” – Hippocrates, 500 BC).

Our key objection is that – whatever the merits or demerits of the clinical judgements that the 31 procedures are over-used – real evidence-based medicine means trusting our doctors, not micro-managing them. Let them do what they feel best in consultation with the particular patient.

This is the basis for our registering ‘patient opposition’ to the whole process.

Also, having to make special cases for funding to the Clinical Commissioning Groups increases GPs’ workload unnecessarily, when they are already struggling to cope.

An average 40% cut to 13 procedures where there’s enough data to set a target

These new commissioning restrictions aim to cut at least 350,000 “spells of activity” for 13 treatments which have sufficiently robust data to set a “reduction opportunity”. This amounts to an average cut of about 40% for these treatments, which include some blood testing for heart attacks patients, along with endoscopies as a first-line for investigation of suspected gastrointestinal disease.

There is not enough data about the other 18 procedures to set a target for restricting access to them. They include colonoscopies, appendectomies, and imaging for shoulder pain.

Instead of these 31 procedures, the engagement document proposes alternatives to be carried out in primary care.

An Advanced Nurse Practitioner commented,

“ Chest xray, Endoscopy, Colonoscopy Wow! And they say with a straight face they hope to detect cancer early. Nuts”

Effects of Covid-19 on hospitals – the context for these cuts to elective procedures

The Expert Advisory Committee, roped in to run the consultation, says that the effects of Covid-19 on NHS hospitals has intensified the need for these the proposed cuts.

Long waiting lists have built up while hospitals were more or less closed for elective care during the onset of the pandemic. In order to give these patients the treatment they need without too much delay, at the end of July, NHS England instructed hospitals to resume near-pre Covid levels of elective activity by October.

But West Yorkshire and Harrogate Integrated Care System’s Director of Improving Planned Care has told us it will not be possible to resume pre-Covid 19 levels of planned care, because of:

“[A]dditional infection prevention and control procedures that are required to maintain safety during elective procedures during the coronavirus pandemic…We also have to plan for the likelihood of local outbreaks of coronavirus and future periods with high numbers of people requiring hospital admission and intensive care.”

Email: Evidence Based Interventions-Wave Two consultation

Please copy or amend this email as you see fit and send it by Monday 24th August to: EBI@aomrc.org.uk

Dear AoMRC,
I have looked at the background to the ‘EBI Wave Two 31 interventions’. As a patient, I am getting in touch to register my objection to this process.
I understand that my doctor has been trained in evidence-based medicine, has my interests at heart, and is best placed to be aware of risks and benefits as well as costs of any particular treatment.

My key objection is that – whatever the merits or demerits of the clinical judgements that the 31 procedures are over-used – real evidence-based medicine means trusting our doctors, not micro-managing them. Let them do what they feel best in consultation with the particular patient.

This is the basis for my registering ‘patient opposition’ to the whole process.

Also, having to make special cases for funding to the Clinical Commissioning Groups increases GPs’ workload unnecessarily, when they are already struggling to cope.

I also understand that many specialist societies within medicine and surgery and the National Institute for Health and Care Excellence produce detailed evidence-based guidelines on interventions. I cannot see the additional value of an Expert Advisory Committee producing recommendations that will result in commissioners restricting some treatments for patients according to imposition of strict criteria.

This seems to run counter to the basic principle of Evidence Based Medicine –“the integration of individual clinical expertise with the best available research evidence from systematic research and the patient’s values and expectations.” Strict treatment access criteria imposed through commissioning undermines the doctor-patient relationship and the importance of the patient’s values and expectations being taken into account.

Please note my objection to the whole exercise, which I feel can only be seen as financially-driven – the result a decade of serious under-funding of the NHS.

Please put doctor and patient back in control, and remember “nothing about me without me”.