AILMENTS like varicose veins and bunions might not be treated on the NHS, as cash cuts start to bite.

The shock news came as NHS Direct said it was planning to shut its call centre in York.

Penny Jones, chief executive of the debt-ridden Selby and York Primary Care Trust (PCT), said some treatments would not be funded by the NHS, except under "exceptional" circumstances.

She was telling a meeting of councillors how local health chiefs planned to save up to £80 million by April 2007. Afterwards, Dr David Geddes, the PCT's medical director, said "low priority procedures" would not be funded where the treatment was mainly cosmetic.

Health bosses also plan to reduce the number of people referred to hospitals by GPs.

Patients barred from minor surgery

PATIENTS suffering from varicose veins and bunions may not get treated on the NHS in North Yorkshire as part of a finance package to save up to £80 million.

The dire financial situation facing the local NHS was outlined to a North Yorkshire County Council Scrutiny of Health Committee by bosses from the region's strategic health authority and Penny Jones - who heads up Craven, Harrogate and Rural District and Selby and York primary care trusts (PCTs).

It emerged that North and East Yorkshire and Northern Lincolnshire Strategic Health Authority's (SHA) area was £39.7 million in debt - although that was less than the £47 million previously forecast.

And North Yorkshire NHS trusts need to make between £70 and £80 million in savings by 2006-07 to bring themselves back into balance by the end of next year.

The cost-cutting move comes in the wake of an announcement last month by York Hospital that it would not be filling 200 vacancies over the next year.

Ms Jones outlined the main savings measures.

"There are some treatments that we will only fund by exception - there will be an appeal process for clinicians," she said.

After the meeting the PCT's primary care medical director, Dr David Geddes said these treatments were "low priority procedures" for conditions like varicose veins, bunions and ganglions - a kind of cyst that sometimes forms in tendons.

Where treatment would be mainly cosmetic, the NHS would not fund the treatment.

But doctors would be able to make specific cases for patients where there was a definite clinical need - such as skin problems caused by varicose veins.

Other measures to save money included:

Driving down hospital referral rates to bring them in line with the national average

Making outpatient follow ups consistent with national best practice

Reducing the number of extra days in a hospital bed

Encouraging GPs to use the most cost-effective drugs.

In Selby and York, figures for 2003-4 show GP written referrals for first outpatient appointments were 28,075 - the average for primary care trusts in England is 19,438. In East Yorkshire, the figure was 22,299.

Since 2002-3, the rate of referrals has rise by 26,000 across the SHA's region - of which 16,000 were in North Yorkshire.

But Dr Brian McGregor, secretary of the York and Selby Medical Committee, said: "There's no evidence that Selby and York GPs are over referring - or that they are referring inappropriately.

"The standard of general practice is extremely high in North Yorkshire, and always has been. I suspect that's what we're being penalised for, that we do pick up illnesses quite quickly.

"If we're not going to be referring bunions, they're going to (have to) increase podiatry - we can't just turn round to patients and say don't be ill."

The meeting heard a proposal for an independent review of health services in the area.

NHS Direct helpline is axed to save cash

NHS Direct is planning to shut its York call centre as part of a cost-cutting reorganisation of the 24-hour health helpline.

The centre, based at Fairfields, off the A19 near Skelton, is one of 12 across the country facing the axe.

An NHS spokesman said three NHS Direct centres were set to shut in the Yorkshire and Humber region, with bases at Doncaster and Scunthorpe likely to close during the current financial year, and York facing closure in the first half of the next financial year, 2007-2008.

He said there was a potential for 66 redundancies in the region, but not all of these would result in job losses - as there were currently 45 vacancies which might remain unfilled, and some staff might be able to re-deploy from closing centres to others elsewhere.

He was unable to say how many staff were based at the York centre, but said employees affected by the changes were nurses, health advisers and administrative posts.

He added there would be a three-month consultation running until August 16.

"NHS Direct commands high public confidence and satisfaction, however, like other organisations, it needs to change if it is to realise its potential in a rapidly changing world," the spokesman said, denying that the changes would hit services to users.

The organisation, founded in 1997 and handling around 6.5 million telephone calls each year, reportedly wants to avert a £15 million deficit for 2006-07.

David Edmonds, NHS Direct chairman, said that like all parts of the NHS, it had to ensure it could deliver a service offering excellent clinical quality for patients and value for money for taxpayers.

He said: "Changes of this scale will impact on staff. We will work with staff-side partners to minimise the impact."

Updated: 09:34 Wednesday, May 17, 2006