Concern over restrictions to surgery for smokers and obese

A MAN who has worked in orthopaedics for 35 years has raised concerns over a new NHS initiative which forces obese people and smokers to lose weight before being allowed orthopaedic surgery.

Last week, The Comet reported on Herts GPs supporting a programme recommended by NHS Hertfordshire - the county’s primary care trust (PCT) - which forces obese people to lose weight before they are allowed knee or hip replacements.

Smokers will also be encouraged to quit before they are allowed orthopaedic surgery.

Before retiring, Bob Smith, of New Road in Clifton, worked for a medical device company which specialises in orthopaedics. He said: “I’m concerned that this will lengthen the time people wait for an operation.

“In the meantime, patients continue taking medication and have pain and limited movement.”


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Mr Smith, who has been a lay member of the patient liaison group of the British Orthopaedic Association (BOA) for 12 years, is also concerned that the condition of a patient’s joint will continue to deteriorate over time, and that a GP is not qualified to assess the urgency of a knee or hip operation.

He continued: “My first thought was that it’s a cost-cutting exercise.

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“I have sympathy for the NHS because it’s a struggle and it’s only going to get worse.”

But he said the implementation of such a programme should not have been made without public consultation.

Mr Smith said he has taken up the matter with the BOA and the issue is due to be discussed by the patient liaison group shortly.

Dr Mike Edwards, Hertfordshire GP and chair of the PCT’s clinical executive committee, said: “This change to the pathway for surgery is not about obese patients or smokers being of lower priority; it is about achieving better outcomes for patients.

“The policy is designed to ensure that all patients undergoing routine hip and knee operations have the best chance of safe surgery and a successful long-term outcome.”

He said evidence shows that obese patients are much more likely to suffer complications during and after surgery, and that wounds do not heal as well in patients who smoke, which makes them more prone to infection.

Dr Edwards continued: “GPs are well placed to make a clinical judgment about a person’s need for surgery.”

He added: “Weight loss clearly takes time and if patients are really unable to make progress over a reasonable period of time then they could still be offered surgery.”

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