Obesity units refusing GP referrals for surgery
By Lilian Anekwe
GP referrals that meet NICE criteria for obesity surgery are being sent back by more than half of consultants as trusts are overwhelmed by a surge in demand, a Pulse investigation reveals.
Trusts across the country are now placing caps on referral for bariatric surgery, with some refusing to take any referrals from primary care.
A separate audit of PCTs obtained by Pulse reveals that even where hospitals accept referrals, many raise the bar over that set by NICE (see box, below).
Hospitals and PCTs have seen a 650% rise in referrals for surgery over the past five years, our findings reveal. It follows a NICE technology appraisal setting out trusts' legal responsibility to provide the treatment for patients who qualify.
Demand is set to be further fuelled by a series of recent studies setting out the dramatic benefits of surgery, with a paper in JAMA last month reporting that 73% of obese patients with type 2 diabetes who had gastric banding surgery were in remission two years later.
Dr David Haslam, clinical director of the National Obesity Forum and a GP in Watton-at-Stone in Hertfordshire, accused trusts of ‘outrageous' behaviour in restricting obesity surgery on the grounds of cost.
‘It's a completely false economy. To limit it on the grounds of cost is disgraceful. Some PCTs refuse altogether, others take 10 or 20 procedures and no more. People will be dropping down dead because of it.'
Current NICE guidance on obesity states patients are eligible for weight reduction surgery if their BMI is greater than 40, or 35 if the patient has severe comorbidities such as diabetes or severe joint pain.
But more than half of the consultants approached – at 20 different hospital trusts – said they were not sufficiently resourced to cope with the huge rise in demand. Some 52% said they were forced to bounce referrals back, leaving GPs to try to manage morbidly obese patients with lifestyle advice and pharmacotherapy.
One in five of the trusts had been forced to formally cap the number of referrals obesity specialists were allowed to see, because of financial constraints.
Dr Ketan Dhatariya, a consultant in diabetes, endocrinology and general medicine at the Norfolk and Norwich University Hospital NHS Trust, said: ‘There is no hope for these individuals. It's a time bomb waiting to explode.'
Professor John Baxter, president of the British Obesity Surgery Society, said provision in Wales, where he works at the Morriston Hospital in Swansea, was ‘among the worst in the country'. He added: ‘To say there's underfunding is a massive understatement. It's appalling. There should be a public inquiry in my view.'How trusts are tightening their belts on bariatric surgery
• 10% of PCTs require a BMI of over 50 in patients without comorbidities
• 3% require a BMI over 60
• 3% require a BMI over 65
• 28% of PCTs require a minimum BMI of 40 or more in patients with comorbidities
• Postcode lotteries exist; an average-height person in Birmingham East & North PCT can be funded for surgery with a BMI of 40, while in neighbouring Heart of Birmingham the BMI benchmark is 65 – a difference of 10 stone