Smokers and the obese face barriers to surgery after Comet country doctors agreed restrictions to routine operations

In one of the first programmes of its kind in the country, Herts GPs have supported recommendations by NHS Hertfordshire, the county primary care trust (PCT), that force obese people to lose weight and encourage smokers to quit before they are allowed orthopaedic surgery.

Patients with a body mass index (BMI) of more than 30 will not be given knee or hip replacements until they have lost weight through a programme supported by GPs and other services. A healthy BMI – a calculation of weight to height – for adults is 18.5 to 25.

Tony Kostick, joint chairman of the clinical executive committee at NHS Hertfordshire and a Stevenage GP, said the move was aimed at reducing the need for surgery, as well as decreasing complications and increasing recovery rates.

“There is good evidence that weight loss can reduce symptoms and may avoid the need for surgery later. For patients who already have arthritis, weight loss will reduce the risk of complications that arise from having surgery and will help them have better results.

Weight loss clearly takes time and if patients are really unable to make progress over a reasonable amount of time then they could still be offered surgery.

Smokers needing routine orthopaedic surgery are now asked to go on at least one session with a trained advisor to receive advice on quitting before being they are added to a waiting list.

The PCT said advisors will explain the benefits of stopping smoking and begin a programme for those who wish to kick the habit. Patients who refuse to go to a clinic will still be added to a waiting list the trust confirmed but the dangers will be clearly explained as part of the consent process.

Dr Kostick said the changes were legally sound and based on “strong clinical evidence”.

Patients are at a higher risk of complications associated with surgery if they smoke or are seriously overweight. Research shows that weight loss, combined with exercise, for patients who are obese can achieve the same level of symptom relief as joint replacement surgery. And for smokers, quitting the habit means that they are more likely to recover quickly from the operation.

He added: “This is about the best outcome for patients. All surgery carries risks and those risks are increased for patents who are obese or smoke. So what we are doing is helping patients to reduce the risk of complications associated with surgery by supporting them to stop smoking or to lose weight before their operation.

Clearly there will also be some cost savings associated with this, especially if patients no longer need surgery as a result of weight loss.

NHS Hertfordshire has a responsibility to make absolutely the best use of NHS resources and we know that the people of Hertfordshire would expect us to do this.”

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