According to Pulse, smokers and obese people will become subject to several new treatment restrictions, unless they alter their lifestyle. The restrictions have been placed by GP commissioners and NHS managers throughout the UK.

In the last year, over a quarter of PCTs reported to have introduced new restrictions on surgery based on lifestyle criteria, yet some PGs argue that the restrictions unfairly discriminate against patients, with one senior lawyer warning that they could be challenged legally on grounds of equality.

According to 91 PCTs freedom of information responses, since April 2011, 25 PCTs have already placed the new restrictions on the treatment of smokers or obese patients, excluding bariatric surgery, whilst 11 PCTs reported to have restricted hip and knee replacements, and nine have restricted IVF treatments. Other PCTs have placed restrictions on breast reconstructions, nipple inversions, and open MRI scans.

Men and women in Cornwall, Devon, Torbay and Plymouth have been banned by the Peninsula health technology-commissioning group to receive IVF treatment unless they have ceased smoking for at least six months. Obese patients under the NHS Bedfordshire cannot undergo hip and knee surgery until they have lost ‘10% of initial body weight or moved below BMI 35′, whilst the NHS North Essex states that patients need to ‘have lost at least 5% weight and have maintained that 5% weight loss for at least six months’.

Even though last year the NHS in Hertfordshire caused controversy by banning hip and knee operations for those whose BMI is higher than 30, as well as for smokers, unless they attended a smoking cessation course, they have now extended their policy to all routine surgery.

According to Ben Troke, a partner at Browne Jacobson LLP, the restrictions would have to be drafted with extreme caution in order ‘to avoid having any discriminatory effect, in appearance or reality, on any particular groups in society’. He continued, saying:

“The public-sector equality duty, under s149 of the Equality Act 2010, would apply to CCGs in just the same way as it currently applies to PCTs.”

Dr. Clare Gerada, chair of the RCGP voiced her opinion, stating that some restrictions, in particular that for IVF treatment, were ‘dreadful’. She argued:

“It’s becoming the deserving and the undeserving. I think it’s discriminatory and I find it astonishing. The Government should determine what should be applied universally.”

The deputy editor of Pulse, Steve Nowottny, concluded:

“Rationing in the NHS is nothing new – but PCTs and clinical commissioning groups are increasingly taking the decision to ration care based on patients’ lifestyle choices. In some cases there may be genuine clinical justification for rationing treatment on these grounds. But there is a growing suspicion that some PCTs are now blocking access to surgery for smokers and the obese simply to help achieve ever-greater efficiency savings. Such a policy has disturbing implications – and GPs are increasingly uneasy about the NHS providing a second-class service to patients with less healthy lifestyles.”

Written by Petra Rattue