The British Orthopaedic Association (BOA) is strongly opposed to arbitrary barriers being imposed to limit the number of patients receiving orthopaedic services.

The BOA is aware that clinical commissioning groups (CCGs) are increasingly using local referral policies to limit certain health services, including hip and knee replacements. Individual CCGs are using patients’ BMI, smoking habit, or pain scores as barriers to limit or delay referrals, even though these factors are unrelated to the patients’ clinical needs. Lifestyle changes that may contribute to better surgical outcome and general health should be supported, but clinical decisions must be made together by patient and surgeon based on individual circumstances.

The BOA draws the attention of the CCGs to the leadership of the profession in establishing and maintaining quality improvement initiatives to optimise efficiency in orthopaedic surgery. The allocation of the NHS’s finite resources should be based on good evidence and appropriate criteria. Knee and hip replacements are among the most cost-effective surgical procedures, and can have a dramatic effect on a patient’s quality of life. There is strong evidence to suggest that very few unwarranted orthopaedic surgeries are being performed, even in those trusts without rationed services.

We consider these arbitrary barriers to be unjust, not based on clinical evidence, and liable to cost the NHS more in the long-term. We call on NHS England and CCGs to ensure that appropriate services are provided at the appropriate time, based on patients’ clinical needs and irrespective of financial constraint.

Advocacy Activities on Rationing of Orthopaedic Services

The BOA has a proactive agenda to advocate on behalf of its members and those patients in need of high quality and appropriate orthopaedic services. Our agenda includes:
• Gathering an evidence base of the extent of rationing of orthopaedic services
• Contributing to the Arthritis and Musculoskeletal Alliance’s (ARMA) advocacy against rationing of joint replacement surgery
• Putting forward representatives for a new NHS England working group on access to surgery

We have also been engaging with the media over rationing of orthopaedic services. BOA President, Ian Winson, was recently interviewed by the Sunday Times; please see here (£) for the article, to which the BOA has already responded.

The BOA supports other organisations that have raised concerns about the rationing of health services. 

Arthritis and Musculoskeletal Alliance (ARMA)

The BOA is a member of ARMA, the umbrella group for arthritis and musculoskeletal organisations. We have been heavily involved with ARMA’s recent work calling attention to the rationing of access to joint replacement surgery. ARMA’s recently released policy position paper can be found here: ‘Rationing’ – Access to Joint Replacement Surgery and Impact on People with Arthritis and Musculoskeletal Conditions.

Royal College of Surgeons (RCS)

The RCS has taken a strong position against arbitrary rationing of health services. The BOA is supportive of the RCS’ position, examples of which can be found below:
Smokers and Overweight Patients: Soft Targets for NHS Savings?
Response to NHS England reported intervention on rationing


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