Vital weight-loss surgery under threat, say GPs

DANGEROUSLY ill patients face being denied surgery for obesity owing to confusion caused by the Government’s controversial NHS re-organisation, GPs have warned.
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There has been a huge surge in NHS operations for morbid obesity in the past decade, with hundreds of people going under the knife in Yorkshire each year.

But bosses of new NHS GP-led clinical commissioning groups (CCGs) yesterday claimed access to surgery was being put in jeopardy due to changes caused by the upheaval in the NHS.

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NHS England has been put in charge of commissioning specialist services including obesity surgery, while councils have been given responsibility for public health including weight loss services.

But problems have emerged because in new national guidelines for bariatric surgery published in April, NHS England said it will pay for treatment only if patients have undergone weight loss treatment for at least a year.

Officials from CCGs say in many areas councils are providing only limited weight loss care, which means hospitals will not be paid if they carry out surgery, although patients approved for operations prior to April will still go under the knife.

The Yorkshire Post understands hospital bosses in Sheffield have already warned they cannot meet NHS England’s requirements, putting future surgery at risk. One service in South Yorkshire offers weight management help for up to three months but in other areas councils are said to be providing “little or none”.

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Yesterday NHS Clinical Commissioners, which represents CCGs, said gaps in essential support services to help control weight were preventing some patients accessing surgery.

GP Steve Kell, chairman of Bassetlaw CCG and co-chairman of the NHS Clinical Commissioners leadership group, said: “We know from many GPs that the specialised commissioning policy for obesity is simply not working.

“As GPs we want to be able to refer patients for services they need, and which have proven benefit.

“These services should be available in all areas and we should not be placed in a position where we have to deny patients treatment because of this.

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“Meanwhile it is essential that NHS England, as the specialist commissioner, shows some imagination and flexibility so that, where it is deemed clinically necessary, patients who need it can be referred now to a surgical pathway for bariatric surgery.

“It is important that patients have access to dieticians, exercise programmes and psychological input where needed, but pathways should include surgery as an option when indicated. Inflexible specialised commissioning policies that don’t take into account national variation and a failure to be flexible has resulted inconsistent provision for patients.”

He said local government had inherited a situation “not of their making” but it was “essential” specialist weight loss programmes were available in all areas.

He added: “Our patients are being let down by the disconnects in provision, we need urgent action to sort this out.”

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Last night NHS England said a working group had been set up to improve commissioning of obesity care, adding it was vital local authorities and CCGs had weight management programmes in place to prepare patients for the major dietary and other changes required for successful surgery.

“Bariatric surgery is a highly specialised procedure and should only be considered for selected patients with severe and complex obesity where the full range of other weight management approaches have been tried, with expert support, but have not been successful,” a spokesman said.

Realities of 24/7 care: Page 13.