Orthopaedics

Decisions on eligibility for procedures are a matter for local National Health Service commissioners and clinicians, taking account of relevant National Institute for Health and Care Excellence (NICE) guidance and the individual needs of the patient. The Department expects access to NHS services to be based on clinical need and informed clinical judgement.

NICE has produced a guideline on joint replacement that covers care before, during, and after a planned knee, hip, or shoulder replacement. The guideline does not make any recommendations on the use of body mass index (BMI) thresholds in determining eligibility for orthopaedic procedures.

As with all surgery, BMI should be considered as part of a holistic, personalised perioperative evaluation of the risks versus clinical need for joint replacement surgery of an individual patient. However, BMI should not be considered in isolation and in and of itself should not act as a barrier to surgery.

As part of the Elective Reform Plan, we expanded Advice and Guidance services, which enable general practitioners and other clinicians to get quick specialist advice from consultants about non-urgent patient care, helping decide on treatment plans, test results, or if a hospital referral is needed. From October 2026, providers are expected to ensure that all appropriate requests and referrals, excluding urgent suspect cancer, flow through a Single Point of Access model, acting as a single ‘front door’ to support clinical triage to the most appropriate service or outcome, supporting faster specialist assessment and meaning clearer next steps for patients.

All providers of healthcare, including independent sector providers, are regulated by the Care Quality Commission and follow a set of fundamental standards of safety and quality, below which care should never fall. The safety of all patients, whether they are treated in the NHS or the independent sector, is a top priority for the Government.