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5 April 2016, 19:41 | Updated: 5 April 2016, 19:47
Six Birmingham health providers have been accused of misusing official guidance to cut the number of people having access to surgery.
The Royal College of Surgeons says it's guidelines have been taken out of context to stop some people getting the surgery they need.
Between them, the CCGs are responsible for the planning and commissioning of health care services for more than two million patients.
Paul O'Flynn, the RCS's lead for commissioning, said in the letter to the heads of the CCGs: "The RCS believes patients' access to treatment must be based on clinical assessment and evidence-based practice.
"We strongly urge you to reconsider your position. The RCS has produced clear guidance, accredited by Nice, and this should be fully taken into account in CCGs' commissioning policies. In this case, our guidance has been misrepresented and incorrectly referenced in many places.''
The RCS said it objected to plans to only fund surgery for irreducible or partly reducible inguinal hernias, or those that cause pain that limits daily activity, or are strangulated or obstructed - which goes against current RCS guidance.
The RCS also objected to a policy of referring patients to hip and knee surgery only if their BMI is below 35 and the plan to only remove adenoids if undertaken at the same time as grommets or tonsillectomy.
It said the policy of only surgically treating more advanced cases of varicose veins was also not based on evidence.
"Varicose veins that are not treated at an earlier stage are likely to deteriorate and require later surgery,'' it said.
It also accused the CCGs of `"misrepresentation of RCS guidance on back pain treatment''.
The letter has been sent to the heads of NHS Birmingham Cross City CCG, NHS Birmingham South Central CCG, NHS Sandwell and West Birmingham CCG, NHS Solihull CCG, NHS Walsall CCG and NHS Wolverhampton CCG.
A spokesperson on behalf of the Clinical Commissioning Groups (CCGs) across Birmingham, Solihull and the Black Country said:
“Along with a number of key stakeholders, the Royal College of Surgeons (RCS) were asked for their views as part of our Procedures of Lower Clinical Value (PLCV) engagement process; we have only just received their formal feedback.
“We have already taken into account many of the valid points raised by the RCS, as part of feedback received through the engagement process, and will continue to do so as we work through each policy.
“Naturally, the review of PLCV policies is very detailed, and includes reviewing all the comments that we have received from our stakeholders to inform our decisions.
“We are very pleased that the RCS has now formally commented, to enable us to make sure their views are considered fully and appropriately.”