LETTER FROM MS GISELA STUART MP, PARLIAMENTARY
UNDER-SECRETARY OF STATE, DEPARTMENT OF HEALTH TO THE CHAIRMAN
OF THE COMMITTEE (WP 1)
At the committee hearing of 17 February on Winter
Pressures in the NHS, I agreed to write about changes in practice
on cataract operations and about GPs charging for influenza immunisation.
1. CATARACT OPERATIONS
It was previously acknowledged that the best
outcome from the removal of cataracts was obtained when the opacities
in the lenses were well advanced ("ripened" or "matured").
It has now been found that there is no clinical evidence to support
this theory and is now generally recognised that patients benefit
from early interventions which will enable them to continue to
work, drive or keep up leisure activities and hobbies.
The Department of Health has recently issued
good practice guidance which advises that referrals for surgery
should be based upon:
— plus, impairment of lifestyle,
— plus, willingness to undergo surgery
where it is judged clinically appropriate.
In quantifying the effect of this change it
is hard to isolate it from the demographic trends which are increasing
demand for cataract surgery. Over the last 11 years the number
of cataract operations in England has doubled with some 170,000
operations carried out in 1998-99. A significant proportion of
the increase must be due to a better appreciation of the optimum
timing of surgery.
2. GPS CHARGING
FOR INFLUENZA
IMMUNISATION
Under the NHS (General Medical Services) Regulations
1992, a doctor must render to his or her patients all necessary
services of the type usually provided by general medical practitioners,
and is not allowed to charge a fee. This includes providing all
immunisations that the doctor considers medically necessary. In
the case of influenza, the vaccine is given free on the NHS for
all those in the "high risk" groups, for whom influenza
is a significant cause of serious illness and death:
— people with chromic respiratory or
heart disease or renal disease, diabetes or people who are immunocompromised,
— people living in long stay residential
accommodation; and
— anyone aged 75 and over.
The final decision as to who should be offered
immunisation is and remains a matter for the patient's medical
practitioner and depends on the individual's medical history.
Patients who do not fall into the above categories can ask for
influenza immunisation but should be aware that they may be liable
to a charge if the doctor is not satisfied that the vaccination
requested is medically necessary, and therefore not required as
part of general medical services.
29 March 2000
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