NHS next year.

So far that is only a news story in the press and the most I have been able to discover is that the proposal is not to ban all carpal tunnel surgery but only to allow it for 'limited indications'. The plan is due to go out for consultation and, perhaps predictably, the hand surgeons are unimpressed as it includes three conditions which constitute a large proportion of their everyday work! To some extent I agree with the principle - there are times when surgery is appropriate and times when it is not and practice in Canterbury is already to optimise the use of surgery so that patients who are most likely to benefit from it get it. My criteria for "indicated surgery" however may well turn out, based on previous experience with PCT and CCG 'guidance' on the use of carpal tunnel decompression, to be rather fifferent to those put forward by NHSE. In previus rounds of this debate people have often suggested that surgery should be reserved for patients with weaknes and wasting of the thumb and a fixed sensory deficit - ie grade 6 CTS - by whch time it is actually too late to get the best results. This is a recipe for making the outcome of surgery look even worse! Of course no-one at NHSE has asked me about it but I will be looking out for the consultation. JB