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Dr Nick Balac: Type of treatment makes all the difference

Dr Nick Balac: Type of treatment makes all the difference
13 April 2017

Type of treatment makes all the difference.

I’m not a betting man but I think if you asked most people if they would prefer surgery for something that could be fixed with medication, I know what the answer would be.

Well in the past, that’s sometimes what’s happened for some health conditions. Doctors may have referred you for surgery when actually there are many more alternatives that would help you manage your condition or improve symptoms.

You’ll know yourself if you’ve ever had an ongoing problem with your knee or hip that your GP will talk to you about what improvements you could expect after surgery and whether there are other things that can make a big difference. Any surgery has risks and often the results afterwards aren’t what you expected.

In Barnsley we’ve been looking to the national experts at the National Institute of Clinical Excellence, or NICE, who have produced a list of conditions where surgery may not be suitable for an individual and certainly not before all other options are tried.

‘Hang on, doesn’t this already happen?’ you ask. Well, yes in lots of cases it does but it isn’t consistent across the borough. That’s why, as a clinical commissioning group, we’ve been talking to GPs, patient groups and hospital consultants about the criteria for when and when not to refer someone for surgery for certain conditions.

Take gallstones for example. You might think that once you know you’ve got gallstones you’ll be referred up to Barnsley Hospital to have them whipped out. Well actually, most people can live with and manage gallstones with no discomfort. It might mean you need to change the amount of fat in your diet. In those cases, where people aren’t experiencing problems why would we put someone through the risk and trauma of surgery? And surely it isn’t a good use of NHS funds for something which doesn’t make a clinical difference?

There are twelve conditions we’ve focused on in Barnsley to make sure people get the best health outcome from the treatments. This ranges from problems with tonsils, trigger finger, hernias, gallstones and Carpal Tunnel syndrome through to grommets, non-cancerous skin growths, cataracts and a hand condition called Dupuytren’s disease.

The experts at NICE have said that all of these conditions, including hip and knee problems, should look at all treatment options before surgery. That’s not to say it’s a one size fits all approach – when I’m sat with a patient we’ll discuss what realistic benefits they can get from different treatments and we'll decide together what could work best for them.

When we talked to members of the public at the Barnsley patient council they were supportive of the work we were doing to get an appropriate and consistent approach for Barnsley people. They also supported getting the best use out of local NHS funding.

They definitely recognised that this approach would need to have the right support out there for people to make this work and as a GP I’d agree. For a couple of the conditions, things that make a difference are being more active or reducing your weight. That’s not always easy if you’re experiencing hip or knee problems, so we want to ensure people know about services such as Be Well Barnsley for example where people are seeing great results.

These guidelines are used in other areas of the country and as a clinical commissioning group for people across the borough, we’ll be monitoring how well they are working at supporting patients to get the very best outcome for their health and wellbeing.