GPs 'rationing hospital care' - Telegraph CCG leaders told the medical journal that any alterations or new policies were "primarily driven by clinical evidence and best practice and not by finance." But the Royal College of Surgeons of England claimed that a number of the treatments being rationed have been demonstrated to prevent more serious complications at a later stage. Scarlett McNally, a member of the college's council, told the BMJ: "Some of the procedures being termed as low clinical value are techniques that have been proven over years to be very helpful to most patients most of the time. If you've got a hernia, maybe you can wait a little bit longer [for surgery], but it causes discomfort, and there is a risk of having a bowel obstruction. That's a much more major operation. Details obtained under the Freedom of Information Act from 195 of the 211 CCGs in England, which assumed responsibility for £650bn of health spending in April, reveal that 27 have tightened existing restrictions or introduced new ones. Some 68 are actively considering altering policies, including some which have already made changes for other treatments, it was reported. Mid Essex CCG has brought in several changes including a new policy restricting the number of patients who will qualify for hernia surgery, and for surgery on certain joint conditions. North East Hampshire and Farnham CCG has brought in measures which will reduce referrals for skin lesion treatment, while others have raised the bar for procedures on bunions and ear grommets. More CCGs have either retained existing restrictions on treatments or introduced new systems to limit the number of patients being sent to hospital, but others have removed restrictions which were previously in place. A spokeswoman for NHS England said: "CCGs are responsible for explaining the reasons for their commissioning decisions. We may intervene where we believe a CCG is failing, or at risk of failing, to meet its statutory duties.