OH practitioners question NHS England plan to limit range of surgical procedures

NHS England has outlined plans to limit a range of surgical procedures, including for common workplace-related conditions such as carpal tunnel syndrome, Dupuytren’s contracture and trigger finger.

The intention is that from 2019-2020 such procedures will only be offered when “specific criteria” have been met. The proposal was outlined by NHS England medical director Professor Stephen Powis in an interview in The Times and is set to be consulted upon until 28 September.

Under the plans, four treatments will only be offered only when a patient makes an individual request. These are: surgery for snoring, dilatation and curettage for heavy menstrual bleeding, knee arthroscopies for osteoarthritis, and injections for non-specific back pain.

A further 13 procedures will only to be offered when specific criteria are met. These are:
• Breast reduction
• Removal of benign skin lesions
• Grommets for glue ear
• Tonsillectomy for sore throats
• Haemorrhoid surgery
• Hysterectomy for heavy menstrual bleeding
• Chalazia (lesions on eyelids) removal
• Removal of bone spurs for shoulder pain
• Carpal tunnel syndrome release
• Dupuytren’s contracture release for tightening of fingers
• Ganglion excision, or removal of non-cancerous lumps on the wrist or hand
• Trigger finger release
• Varicose vein surgery

Powis argued that, for most of procedures, alternative treatments such as physiotherapy, a minor injection or change of diet could be equally effective.

He said: “If we want the very best clinical care for our patients, we need to stop putting them through treatments where risks and harms outweigh the benefits. By reducing unnecessary or risky procedures for some patients we can get better outcomes while reducing waste and targeting resource to where it is most needed.”

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However, the plan has already been questioned by OH practitioners, with one post on the UK Occupational Health Practitioners’ Facebook group describing the move as potentially opening “a huge can of worms for the management of many work-relevant health issues”, such as worker handling of vibration tools.

The move has also been criticised by David Shewring, president of The British Society for Surgery of the Hand. He said: “Carpal tunnel syndrome, Dupuytren’s contracture and trigger finger are common conditions which have a significant detrimental effect on quality of life. Timely treatment for these conditions is effective in relieving symptoms, preventing irreversible loss of function and keeping patients in employment.”