Some patients are facing long delays for surgical treatment because clinical commissioning groups are ignoring evidence-based guidelines for when to provide surgery, according to a damning report by the Royal College of Surgeons. 

This has uncovered evidence showing that some CCGs are "imposing arbitrary referral restrictions and denying access to vital surgical procedures", which, it points out, could significantly improve the quality of life for patients.

Analysing data garnered from Freedom of Information Act requests, the RCS found that 73% of those CCGs reviewed do not follow clinical or National Institute for Health and Care guidance on referral for hip replacements, or have no policy in place for this procedure. 

Patients in pain

And, shockingly, 44% require patients to be in various degrees of pain and immobility or to lose weight before surgery, which the College says is "unacceptable".

Also, an analysis of commissioning policies at 52 of England's 211 CCGs, relating to common surgical procedures carried out on the NHS, found that only 27% had policies that complied with NICE or surgical guidance on inguinal hernia repair and 58% had none at all, while 15% required evidence of a hernia increasing in size or a history of reoccurring problems, even if a patient is in debilitating pain.

Motivation may not be financial

"The motivation may not be financial but it is clear that some CCGs do not commission services using clinically accepted evidence-based guidance," said Clare Marx, RCS president, commenting on the findings.

The College is calling on the Government and NHS England to act to remove the current postcode lottery of access to surgery and ensure equitable care for all patients.

In an emailed statement, a spokesperson for NHS England said that "decisions about what care a patient gets must be taken by clinicians on the basis of what that individual needs" and that the organisation "is working to help CCGs to make the right choices around spending by presenting them with useful data which shows how extremely successful operations such as replacements are".