Overcoming barriers in hallux valgus surgery: an assessment of variation in clinical commissioning in England

Abstract

Background/Aims In 2014, the Royal College of Surgeons expressed concern that a postcode lottery was determining the commissioning of procedures of limited clinical value. The research was carried out to assess whether there is variation in the clinical commissioning of hallux valgus surgery in England. Methods The commissioning policies for clinical commissioning groups were identified. Data were analysed to assess both adherence to the British Orthopaedic Association guidelines for surgery and the minimum criteria that a patient must fulfil for surgery. Results Variation was recorded in commissioning policies and in the number of criteria a patient must fulfil to be offered surgery. Conclusions There is currently no standardised national commissioning policy for hallux valgus surgery. Referral guidelines have been produced by leading national bodies but their implementation is varied. This can lead to variation in referral patterns in England for patients requiring hallux valgus surgery.