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Practice updates

Private Bariatric (Weight Loss) Surgery

Management of patients who have undergone private bariatric (weight loss) surgery

NHS Scotland’s position is that travelling abroad for surgery without an NHS referral is not recommended and that NHS Scotland is under no obligation to provide pre and post operative care other than emergency care. For the purposes of bariatric surgery, the post operative period is classed as the first 2 years’ post surgery.

Primary Care clinicians are not obliged to prescribe for or monitor patients who have undergone bariatric surgery privately. The responsibility for post-surgery monitoring and prescribing sits with the private provider. This includes all monitoring and prescribing (including the prescribing of alternative formulations of prescribed medications e.g. liquids or effervescent during the patient’s recovery period). This is necessary due to the specialist expertise and care required during this time period.

Information for patients who are considering weight loss (bariatric) surgery out with the NHS

In line with NHS Scotland recommendations NHSGGC supports the position that travelling abroad for surgery without an NHS referral is not recommended and that NHS Scotland is not required to provide pre and post-operative care other than emergency care (NHS Inform).

The British Obesity & Metabolic Surgery Society currently recommend that bariatric surgery is a complex intervention which requires at least 2 years of support from a specialist team with dietetic, nursing, psychological and surgical expertise.

Routine monitoring, routine follow-up and prescribing of associated medicines, immediately after weight loss surgery and for the following two years is the responsibility of the private provider, ideally the practitioner who undertook surgery. This is to ensure the appropriate aftercare for patients who have undergone weight loss surgery.

During the two-year post-surgical period GP practices are not obliged to provide routine monitoring, routine follow-up, prescribing of alternative formulations of medicines or prescribing of new vitamin/mineral supplementation.

Where a private consultant/service cannot provide routine monitoring, routine follow up or prescribing of medicines or supplementation it will be the responsibility of individual patients to source these services and prescribed medications/supplements.

 

Care and prescribing after weight loss surgery outside the NHS

Weight loss surgery is a package of care. The operation is only one part of treatment. You’ll need routine care before and after the actual operation. NHSGGC is under no obligation to provide this (see NHS Inform for more details). NHSGGC will provide care in an emergency or if you are pregnant.

Care during the first two years after surgery

Your GP does not have to provide routine care for the first two years after weight loss surgery. This care is the responsibility of the private surgery provider. If your private provider cannot help, it is up to you to find and pay for these services. This includes:

  • Blood tests– Routine blood tests during the first two years must be arranged by the surgery provider. If they can’t, you’ll need to arrange these yourself.
  • Specialist follow-ups– The surgery provider is responsible for follow-up appointments in the first two years. If they don’t offer this, you’ll need to arrange it.
  • Medicine changes– If the private provider recommends changes to forms of medicines (e.g. liquid forms), they must provide prescriptions for them.
  • Nutritional supplements– Everyone who has weight loss surgery needs lifelong nutritional supplementation. For the first two years, the private provider is responsible for prescribing/supplying these.

 

Care after two years

After two years your NHS GP can take over the annual monitoring and prescribing of nutritional supplementation you will need for life. NHS prescriptions and care will follow NHSGGC guidelines, which may differ from what your private provider recommends. GPs cannot provide these services before two years, as specialist monitoring is needed during this time.

Further information

NHS Inform: Surgery abroad without NHS referral | NHS inform (www.nhsinform.com, search ‘surgery abroad’)
BOMSS: BOMSS statement on going abroad for weight loss surgery (www.bomss.org search ‘going abroad for weight loss surgery’)