Weight Management (including Private Care)

Obesity and overweight are significant problems for many of our population and there is increasing interest in lifestyle changes and other methods of help. Obesity costs the NHS around £6.5 billion a year and is the second biggest preventable cause of cancer. Over one in four (26%) adults and 23.4% of children aged 10-11 years in England are living with obesity, placing huge pressure on the health and care system.

Please see our practice website for information and signposting for dietary and lifestyle changes. We also have some information about medications to help with weight loss and the current issues with getting access to them (these are not prescribed by the practice).

While weight loss surgery is one method for reducing weight that has proven effective, in situations where people have struggled to lose weight using other methods, it is a major intervention and comes with significant risks, as described later in this policy. For this reason, weight loss services aim to fully exhaust diet and lifestyle measures before exploring this option.

A variety of weight management services are available to patients with a BMI of between 30 and 45 (27.5 if you have diabetes or hypertension or have a high-risk ethnic minority background), including Slimming World or the Digital Weight Management program offering 12 weeks of structured support. Surgery is reserved for those people who have the highest risk of serious health complications because of their weight. In deciding on this intervention, you will need to carefully balance the risks to your health of your weight against the risk of surgery and make sure you have explored all options.

All patients are entitled to NHS care, free at the point of need. However, this applies to care that the NHS has agreed to fund in your area for patients meeting the agreed criteria. In deciding what care to fund locally the Lancashire and South Cumbria Integrated Care Board (ICB) has the difficult task of weighing the cost of delivering a service against the benefits it could provide to their patients. They then consider if this is the most effective use of their budget when compared to funding other medical care.

Locally bariatric surgery is organised by the Tier 3 Local Specialist Obesity Service. Those with a BMI of 35+ can be referred if they have an obesity related co-morbidity. Their team includes dieticians, occupational therapists, psychologists, and a specialist consultant. Patients who meet the criteria for this service and would like to access it will be offered an appointment with one of our Healthcare Assistants who will discuss their weight problem, offer advice, and make the referral. There is currently an 8-month waiting list. They will not accept referrals for those with any weight-loss surgery within the last two years (these will be followed up by their surgical team). They will follow up those who have had NHS funded weight loss surgery after two years, including an annual review appointment.

When considering the cost to the NHS of providing an intervention the ICB considers not only the cost of providing the operation itself but the cost of any short-term or long-term consequences of the surgery. This will include specialist monitoring before and after the operation as well as the very high cost of emergency and intensive care treatment if something goes seriously wrong.

The risks of weight loss surgery are explained at Weight loss surgery – Risks – NHS (www.nhs.uk) but include blood clots, wound infection, the gastric band slipping out of place, a leak in the gut, a blocked gut, malnutrition, gallstones, excessive skin and a risk of dying as a consequence of the surgery. It is also important to note that most types of weight loss surgery result in permanent vitamin and mineral deficiencies that need to be proactively managed with long term supplementation.

In choosing to fund a weight loss operation privately you are taking responsibility not just for the cost of the operation but for providing the necessary specialist care afterwards. For this reason, we warn people to consider these costs and risks before undertaking surgery abroad and to make provision for their care on return to the UK.

We strongly advise patients against undertaking weight loss surgery abroad. Weight loss surgery is all major surgery and as such has considerable risks (see above). There is also a significantly increased risk of DVT (deep vein thrombosis – blood clot in the leg) and PE (pulmonary embolism – clot in the lung) in the short term, exacerbated by flying. Most UK surgeons advise waiting 6 weeks for that risk to go down before considering taking a flight.

Some of our patients have already accessed weight loss surgery abroad and we have found that many of them returned with inadequate discharge information and advice about longer term monitoring and supplementation that was not in line with UK guidance.

As General Practitioners we do not have specialist training in all areas of medicine and surgery. We are required to work within our competence to provide safe care. The Medical Defence Union has provided advice about how GPs should practice safely in this area and has significant concerns about the medicolegal risks of us taking on monitoring outside our competence.

When someone has weight-loss surgery in the UK patients are normally followed up by a specialist who organises blood testing for various vitamin and mineral deficiencies as well as the other potential complications outlined above. Any reputable UK private provider should also be offering this package to patients they are providing weight loss surgery for.

After an initial 2-year period of monitoring a patient is discharged back to our care shared with the Tier 3 weight management service (for NHS patients).

We sometimes accept shared care of a patient with an NHS consultant who requests we take certain blood tests or prescribe medication. This is on condition of providing us with guidance and access to specialist advice.

We cannot accept shared care arrangements with private medical providers in the UK or abroad. See the private prescribing policy on our website.

All weight loss surgery causes lifelong issues with deficiencies in various vitamins and minerals. Advice from providers abroad may not be accurate. Attached below is standard advice from our local NHS Medicines Group. As you can see, even for patients getting NHS surgery, it is their responsibility to purchase vitamin supplementation available over the counter.

supplements-post-bariatric-surgery-version-16.pdf (lancsmmg.nhs.uk)

The surgery you have planned may cause a deficiency in vitamin B12. Some patients who have had weight loss surgery will require B12 replacement injections throughout their life. This would be the direct consequence of your privately funded care and you would normally be responsible for funding this throughout your life. There are many private providers of this service.

Unfortunately, the local NHS (Lancashire and South Cumbria ICB) does not currently commission any services for long term routine follow up – either monitoring or provision of B12 injections – for patients who have accessed private weight loss surgery. It is not something that is covered by the existing General Practice Contract. Please see the statement below from the Lancashire Coastal LMC (Local Medical Committee representing General Practices) which has also been agreed by the ICB.

This letter is shared in response to your request for post-operative support from your GP following bariatric surgery you accessed privately. Aftercare for patients who have self-funded bariatric surgery is not routinely commissioned by Lancashire and South Cumbria ICB within the NHS locally and is not available from The Thornton Practice.

The post-operative support you have asked for requires specialist input that may be available from the provider that undertook your surgery or via an alternative self-funded route. Specialist NHS services provide this aftercare for patients who have undergone their bariatric surgery within the NHS.