DOCTORS have complained they are increasingly having to make special requests to fund previously routine operations such as hip replacements and knee surgery – leading to lengthy delays for patients.

Figures show that so-called individual funding requests (IFRs) to Clinical Commissioning Groups across the region have rocketed in recent years amid claims of a “misguided attempt” to save money by reducing the number of procedures carried out.

This “extra layer of red tape” requires GPs to compile supporting evidence and even then there is no guarantee that an IFR – which can cover anything from cataract removals to hernias, simple cosmetic surgery and fertility treatment – will be approved by CCGs.

The British Medical Journal, which compiled the figures, said IFRs had increased by 47 per cent over the past four years in England and described how pressure on NHS finances was driving a “new wave of postcode rationing”.

In Darlington there were 840 requests to the CCG in the past financial year, 2016/17, up from 179 in the previous 12 months, a near 475 per cent rise.

The neighbouring Durham Dales, Easington and Sedgefield CCG also experienced a large year-on-year rise in IFR applications from 467 to 1,586. Other CCG areas showing increases included Newcastle and Gateshead.

In 2015/16 it received 1,552 funding requests, but in the last 12 months this went up to 2,476.

GP George Rae, chief executive officer of Newcastle and North Tyneside Local Medical Committee, said he had made more IFRs in the past few months than in the past and was getting more refusals.

He said in one case a woman wanted a substantial sebaceous cyst removed, but the IFR was refused, meaning she had to put up with it or go private.

He said: “Making IFRs is undoubtedly more work and more bureaucracy for the GP.

“It also means the patient has got to wait and significant disappointment if it [the application] comes back negative.”

In some areas GPs have been given more guidance on when to refer for so-called “limited value” procedures.

Dr James Carlton, a medical advisor to the Durham Dales Easington and Sedgefield CCG, said there had been an agreed contractual action with local providers that procedures of limited clinical value should not be undertaken without a formal IFR and what he called a “prior approval ticket”.

He said: “It can be seen as an increase in administrative work, but it is a mechanism for ensuring that the policies are consistently applied both in primary care and secondary care, reducing variation.”

Stephen Cannon, vice president of the Royal College of Surgeons, said CCGs were misguidedly imposing restrictions on treatments to save money to the detriment of patient care.

Richard Vautrey, deputy chairman of the British Medical Association’s General Practitioners Committee, said NHS England should set out guidelines on which treatments should be routinely available without an individual request.

Julie Wood, chief executive of NHS Clinical Commissioners, which represents CCGs, said “difficult decisions” had to be made over which services to fund.

She said: “The NHS does not have unlimited resources and ensuring that patients get high quality care against a backdrop of spiralling demand and increasing financial pressures is one of the biggest issues CCGs face.”