GP and Patient

Planned Care (2018)

We asked

Planned care is the term used to describe the non-emergency operations and treatment that are carried out in hospital and in the community, with appointments arranged in advance. Some examples of these are hip and knee replacements, operations to correct a cataract, joint injections and varicose vein surgery.

We want to make sure that patients only have procedures, such as operations, where we know that this will be effective for their particular medical problem and circumstances. Any procedure carries a small risk of complications, so we need to know that a treatment is right and will help the patient. Policies are used by health professionals to give clear guidance on when a referral should be made for treatment in hospital. Policies also make sure that NHS resources are used in the best possible way and are used fairly for everyone.

Our local doctors looked at 101 policies to decide whether they were suitable for patients in Leicester, Leicestershire and Rutland and made some minor changes:

  • 49 existing policies would not be changed
  • 2 existing policies would be changed so that patients receive better care. Any treatment that is given would be based on best medical advice and be the right decision for their individual medical problem.
  • 50 new policies would be introduced. The new policies simply describe what is already happening in Leicester, Leicestershire and Rutland although they did not currently have a formal policy in place.

Between the 20th August and 26th September 2018 we asked patients, carers and members of the public about 101 policies. We wanted to know whether patients were aware of these policies and understood them, whether they had any questions about them and if there was anything else that they thought should be included.

 

You said

The response rates for the public engagement was low. Similarly attendance at the public events, in each of the CCG areas was also low.

From an online and paper survey, 3 public events and visits to out-patient clinics, we received 27 completed surveys. 20 were specifically about the hip and knee policy; the other policies that received comments were cataracts, ear wax removal, Screening for Obstruction sleep apnoea and Utero vaginal prolapse.

Despite a low response, the feedback received from patients, carers and the public has been incredibly valuable, not only as part of this engagement but also informing the wider planned care transformational plans

The overall responses were broadly positive and none of the comments received raised any concern for any policy presented. There were suggestions made for minor adjustments to a small number of policies.

 

We did

The table below details the feedback received and any changes made to the policy as a result of the feedback.

Policy Referred to Patient feedback Any changes made to policy
Cataract Although visual acuity is mentioned as a criterion, nothing is stated regarding macular degeneration. If a patient is suffering from either wet or dry types, should they not be treated earlier as this will enable ophthalmologists and doctors to assess the severity, treatment or worsening of the condition. No changes made to the policy as comments relate to macular degeneration
Referral for Obstruction Sleep Apnoea I understand sleep apnoea may cause seizures in some people. Please could you include this as a reason for allowing screening. No changes made to the policy. The self-assessment tool covers the impact of sleep apnoea on the patient’s life. If the sleep apnoea was having a negative impact on the patient’s life, this would be apparent in the self-assessment
Hip and Knee Replacement Frailty of the patient is not mentioned (eg existing osteoporosis) as to assessing the need for the surgery nor the likelihood of the patient hurting themselves should they fall as a consequence of another condition eg epilepsy. Both these should be considered as although the patients may be referred sooner, it may save the primary care service money as they could be in hospital a lot longer if the surgery was delayed. No changes made to the policy as the threshold for surgery is dependent on pain, functional impairment and radiological assessment. If the patient’s hip or knee was causing “frailty” this would be identified in the functional assessment.
Hip and Knee Replacement Why are these being restricted or treatment with held,when patients who have already had one replaced and have been told by their consultants on more than one occasion in their after care time that they need to get the other one done, but on going to their GP are told that they have to go through extremely useless physio treatment first. They have been on it and are a lot worse off than when they started and are going rapidly down hill due to the extreme pain it caused, but STILL cannot get the GP to put them forward. No changes made to the hip and knee replacement policy as there is provision for an urgent referral – without 3 months conservative treatment, if the referrer thinks that this is appropriate
Hip and Knee Replacement The Threshold criteria fits with my treatment. Yet I know others who have had replacements but are not as bad. Why such difference in treatment? I am not complaining as I am grateful for our NHS and will continue to support it. No changes made to the hip and knee replacement policy. The purpose of having a policy for hip and knee replacement is to reduce variation of practice.

You can read the full report here: Planned care policies public engagement report