"WE are now rationing the health service." That was the reaction of senior York GP Dr Brian McGregor to documents obtained by The Press which sets out proposed curbs on a range of NHS treatments, including hip operations and vasectomies.

Dr McGregor said some of the proposals could leave patients "virtually housebound" before they could get operations on the NHS.

SOME patients could be left "virtually housebound" before they are allowed into hospital under new proposals from NHS chiefs.

Now The Press can reveal the first details of multi-million pound cost-cutting plans to streamline local health care.

North Yorkshire GPs have this week been sent a working document - seen by The Press - which sets out how patients should be treated for a range of different conditions.

The document forms part of primary care trust (PCT) commissioning plans, which will set out how they plan to save millions over the next financial year.

The joint cash shortfall of the newly-merged four North Yorkshire PCTs is £51million.

The document's proposals include:

Plans to limit the availability of sterilisation - a vasectomy for a man - where there is not a clinical need

An increased level of pain and discomfort for osteoarthritis sufferers needing hip and knee replacements before they should be seen in hospital

A threshold for cataract operations

York GP Dr Brian McGregor, secretary of the Selby and York GP committee, said: "Effectively, it's rationing.

"We are saying to people that some conditions are now to be considered not severe enough to require NHS treatments.

"I think these guidelines have been released inappropriately, and have been developed in a way that will impact heavily on patient care and on the GP and PCT relationship."

Jim Easton, chief executive of York Hospital, said some elements of the proposals - including those for orthopaedic patients - did cause "particular concern".

He said: "It's essential for good patient care that there's a strong and good relationship between GP colleagues and the hospital and the PCT, and so while there are clearly some differences of view it's important that we find ways of talking about those and not leaving patients in the middle of these issues."

Under the proposals, GPs are being advised that orthopaedic patients with osteoarthritis needing hip and knee replacements should reach a certain "level" of pain and difficulty in their everyday lives, on a scoring system known as the New Zealand scale.

Patients who measure a certain score should be referred to hospital. But under the new proposals, this has been increased from 65 out of 100 to 70.

Dr McGregor said this would mean they were "virtually housebound".

Under the proposals, patients who score between 40 or 69 should be managed with an assessment by non-surgical treatments like physiotherapy - but according to the document it will only act as a guide in decision making and will not "override clinical judgement".

Morag Francis, secretary of the York Orthopaedic Support Group, said: "This is very serious.

"There are so many degrees of pain, it's difficult to assess people.

"I think it's dreadful the way we are like numbers and targets."

Dr McGregor also feared the level of sight loss of patients needing cataract operations had also been increased - but the primary care trust has said this was not the case.

Dr David Geddes, from the trust, said the document was still under discussion with medical colleagues.

'Third World' service for those wanting vasectomy

ONE York GP said proposals to cut down the availability of vasectomies were "reverting to Third World status".

Previously, men have been referred to hospitals after simply telling their doctor their family was complete and they did not want more children.

Now, that procedure and female sterilisation could no longer be available on North Yorkshire's NHS simply on request.

Instead, GPs are being advised that the Mirena coil is as effective as a female sterilisation, and should be considered as an alternative.

Hospital referrals for both sexes will be considered "on the basis of clinical need and a lack of appropriate non-surgical alternative".

Dr David Fair, from York's Jorvik Medical Practice, said: "A vasectomy is one of the safest, most reliable forms of contraception available. If vasectomies are to be made more difficult to obtain on the NHS it will inevitably lead to unwanted pregnancies.

"Provision of effective contraception is one of the markers of civilised society and to reduce its availability is tantamount to reverting us to third world status.

"To get it on the NHS people are going to have to jump through lots of hoops and hurdles.

"It's difficult enough for many men to pluck up the courage to get to the GP in the first place to request a vasectomy, but then to have to go from treatment to treatment, to see different people in order to end up having it justified, is just going to put men off having a vasectomy at all."

Dr David Geddes, medical director for Selby and York Primary Care Trust (PCT), said: "My view is that actually there is a cohort of patients who are happy coming along (and saying they've) completed their family, and will have a sterilisation now.

"And that's fine, but there's nothing wrong with the contraception they've been using for all those years.

"Is it reasonable that we pay for that, if someone says I've finished with my family?"

But there might be clinical reasons for offering sterilisation, he added, such as a woman on the contraceptive pill smoking and being overweight.

Fighting for sight

THE Press ran a successful campaign to cut waiting times for vital eye operations in York.

Back in 2000, bosses at York Hospital won £500,000 from the National Action For Cataracts initiative towards the creation of a new integrated ophthalmology department.

The result was a major coup for our Fight For Sight campaign, which focused on long waiting times for often elderly people wanting cataract operations.

It highlighted the case of the late Jean Heaven, from Haxby, who spent £1,850 of having a private cataract operation on one eye to avoid a long wait, then found herself pushed to the back of the NHS queue for treatment on her other eye.

The Press reported in July 2000 that the integrated ophthalmology unit would bring all services into close proximity to help improve the speed of treatment.

Proposals only 'first step'

DOCTOR David Geddes, Selby and York Primary Care Trust's medical director for primary care, said the purpose of the document was to make sure NHS treatment offered across North Yorkshire's new "super trust" area was the same.

"This is the first step in bringing together lots of guidance which has been in existence either nationally or locally," he said.

"What we needed to do was to bring together what the current state of play was.

"We need to be clear with our provider trust (York Hospital) exactly what we're going to commission and what we're not."

He said the "70" score required for hip and knee replacements was the same level as the neighbouring trust in Bradford. It was used as an "adjunct" to clinical assessment.

Patients scoring 40 to 69 would be given an assessment at the hip and lower limb service, which was "very thorough".

This gave patients an "additional assessment" before they went to hospital - and some people in this group would not need to go.

"Actually, the scoring is good and it helps us. It's not like a threshold, which is absolute," he said.

Responding to complaints that GPs had not been involved in discussions about the proposals, he said: "It's been a very difficult time at the moment. "The proposals are a working document. We can work on this. It's not anything new for us."

Measuring pain

THE New Zealand scale measures patients on "priority criteria" for major joint intervention for hips and knees.

Divided into sections including "pain" and "functional activity", it gives a set of scores which measure how much a person's life is affected by their condition.

Pain levels can range from "mild" to "severe". Patients are also judged on how far they can walk and other limitations in their life, for example putting on shoes or managing stairs..

What it will cost to have an operation privately:

Hip Operation: £7,000 - £9,000

Total knee replacement: £8,000 - £10,000

Varicose veins removed from both legs: £2,100 - £3,000

Vasectomy: £300 - £900

Cataract removal: £1,600 - £2,700

Source: Private Healthcare UK.

KATHRIN TREACY asked people what they thought of the proposed scoring system

Derrick Dawson, 70, retired from Clifton, York

"People should be referred earlier before it gets to the point of extreme pain. I sympathise with those who do need an operation."

David Farr, 71, a volunteer from York

"I meet a lot of people in need of hip replace-ments; who have to struggle just to get out of a mini-bus. The NHS should be making their lives easier not harder."

Tom Whall, 85, a retired soldier

"This is typical of the people who run this country; they can't use their initiative to treat people. This country is in a sad state, it's now a third rate country."

Matthew Dolton, 70, retired from Harrogate

"I had both of my hips repaired ten years ago; I paid to have it done privately. I think that the NHS is a brilliant system, but I didn't trust it."

Rodney Mitchinson, 83, retired from York

"It doesn't seem right to make people wait when they are in pain. If I had to wait, I would pay to go privately but it is not fair to those people who can't afford it."

Case study: Two-year wait forced Sky to go private

IT'S not only the elderly who suffer from cataracts.

Sky Ferrey, 58, formerly PA to the editor at The Press, found that out to her cost at the age of 40, when her optician first told her cataracts were beginning to form in each of her eyes.

By the age of 51, her sight had deteriorated to the point that she needed an operation to be able to continue doing her job.

In 1999 Sky was told she would have to wait two years to have her operation on the NHS, and in the end opted to go private and had cataracts removed from both eyes at the Purey Cusp Hospital in York, at a cost of £1,800 per eye.

She had been dependent on inhalers since she was young to keep her asthma under control - and experts said her cataracts could be due to the steroids they contained.

Sky, of Bishopthorpe, said she was "appalled" at the thought that some NHS cataract operations could be put on hold as a result of cut backs.

"I was quite young when it happened and it was just like a fog being lifted. It was completely life-changing," said Sky.

"I'm appalled because many of these people who suffer from cataracts are elderly and have been paying towards the NHS all their lives.

"Old people have so few pleasures in life these days that don't cost a lot of money and this operation means they can read a newspaper, watch television or read a book, simple pleasures we all take for granted."

Updated: 10:58 Friday, May 19, 2006