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GPs face ban on routine bariatric surgery referrals amid CCG review

GPs in one area could face a complete ban on routine referrals to weight-loss surgery under CCG plans out for public consultation.

Under the plans, NHS Basildon and Brentwood CCG is looking at only funding bariatric surgery in ‘exceptional’ circumstances.

This comes as part of itss 'service restriction and policy review', which looks at withdrawing or restricting a whole range of services in a bid to tackle a £14m deficit.

The CCG said that rather than funding bariatric surgery, it would focus on to promoting healthier lifestyles to stop people becoming obese in the first place.

But NICE says bariatric surgery should be an option if a patient has a BMI of 40 or more, or between 35 and 40 and other significant disease such as diabetes and high blood pressure, as long as 'all appropriate non-surgical measures' have been tried and failed.

And a leading GP obesity expert, who fears the move could lead to other cash-strapped CCGs following suit, warned that such preventative measures would not help existing patients with severe obesity and would set back progress made in fighting obesity-related illness.

Although there have been previous reports of CCGs restricting access to the procedures by, for example, setting a higher BMI threshold, this is thought to be the first time routine GP referrals for bariatric surgery would be blocked completely.

NHS Basildon and Brentwood CCG said on its website: ‘As part of a wider review into service restrictions Basildon and Brentwood CCG is proposing not to fund weight loss surgery: gastric band; gastric bypass; sleeve gastrectomy.’

It said it would 'consult on not providing this service to the population and instead work with Public Health to promote healthier lifestyles and tackle obesity rather than managing the problem once it occurs'. It said that ‘through working with Public Health and our providers to support people to better manage their conditions and engage and participate in improving their wellbeing the need for bariatric surgery should decrease whilst outcomes for patients should improve’.

It added that ‘where there is a pressing clinical need, cases will be considered on an exceptional basis’.

The CCG confirmed to Pulse that it only took on commissioning responsibility for bariatric surgery from April this year, which meant it had received 'the historic level of funding for this surgery' from NHS England, which would 'become part of our future baseline income'.

A spokesperson added: 'Any decision on eligibility or provision of bariatric surgery is now determined at a CCG level. As part of our Fit for the Future consultation, Basildon and Brentwood CCG is currently consulting on whether we will continue to commission bariatric surgery (alongside a number of other proposed changes).'

Essex LMC chief executive Dr Brian Balmer said this was 'an interesting decision' as 'some would say it makes more economic sense to fund it'.

He added: 'It’s no secret the health service in Essex is in dire straits and very very short of money, and the NHS are desperately trying to fix it, allegedly through efficiency.'

Professor David Haslam, GP and chair of the National Obesity Forum, told Pulse: ‘This is what we feared when commissioning for tier 4 was passed over to CCGs, as bariatric surgery is poorly understood by many CCGs, and neither the beneficial health, nor economic consequences are being considered.

‘Bariatric surgery is intended for the severe and complex obese population, for whom prevention is a little late, and the only hope of regaining health and quality of life is a sleeve gastrectomy or bypass.’

Professor Haslam added that while NHS England has funded the surgery 'we have been able to make a lot of progress, reversing diabetes and sleep apnoea, which will have saved the NHS a fortune'.

But he said: 'What we are fearing will happen is there might now be a domino effect with a reduction in commissioning.'

In other measures, NHS Basildon and Brentwood CCG is following neighbouring CCGs in proposing to completely stopping funding for both male and female sterilisation as well as cutting back on some treatments, such as limiting IVF.

It comes as other CCGs facing large deficits are in the process of pushing through new cost-saving measures, including cuts to GP enhanced services branded ‘short-sighted’ by local GP leaders.

An NHS England spokesperson said: ‘Decisions when prioritising resources are always very difficult for commissioners but it is up to CCGs to make the best decisions for their area.’

Readers' comments (13)

  • In the extremely obese what is more efficacious, surgery or lifestyle interventions. I thought it was the former?

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  • Tax on takeaway food with a 10% fat to fund?

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  • Azeem Majeed

    There is increasing evidence that bariatric surgery is an effective procedure, particularly for obese people with type 2 diabetes.
    http://archsurg.jamanetwork.com/article.aspx?articleid=2475971

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  • So let's get the terminology correct - this is RATIONING, and EXCLUSION of services, and is totally against the principles of the NHS that care is available and free at the point of need. 'The best decisions for their area?' - no: in NHS terms these are surely invariably wrong decisions, whichever way the decision falls. NHSE shouldn't be hiding behind weasel words.

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  • The true fact is in the very obese nothing is effective.

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  • My CCG only offer it on those with a BMI under 25. It's saved a fortune.

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  • don't refer patient TO HOSPITAL, do not ask for bariatric surgery, don't use nsaid for oa. don't clogg up A and E, admission avoidense DES. 7 days service but
    no seniority payment, no mpig in long run. cge, pension contributation.
    GO TO CANADA, Australia

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  • CCGs continue to be very short sighted regarding Bariatric Surgery. Not only is there clear evidence it saves lives but for those with type 2 diabetes where the patient is going onto injectibles then surgery is net saving within a couple of years.
    Then your saving lives and money.

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  • Vinci Ho

    You see
    The impression given here by our famous professor is NHSE was the good guy funding the operations . But now the buck has been passed to the 'bad guys' called CCGs(which are GPs by definition). The question here is who is the submissive ? Who is the dominant? The so called devolution of power is a landslide fallacy if there is a hidden agenda from the dominants higher up the hierarchy .

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  • Lifestyle advice DOES NOT WORK! I do feel disgruntled at times that my taxes are essentially helping fund a treatment to negate the effects of bad lifestyle choices, but at the end of the day bariatric surgery can be life changing and life saving, and may help prevent a whole range of medical conditions. Are we going to stop funding smoking cessation services, exercise on prescription and alcohol services which, in my opinion, have very little impact on long term health outcomes.

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