GPs in some areas have been blocked from referring patients for bariatric surgery, because of the ‘fragmentation of services’ that commissioners claim has occurred since April.
Pulse has learnt that the intensive weight loss programme patients must now go through before they can be referred for bariatric surgery are currently not available in some areas.
Since April 2013, NHS England has stipulated that all patients must first attend tier three weight management services for up to two years before they can be referred for bariatric surgery, but in some areas these tier three services have yet to be commissioned.
Dr Steve Kell, chair of NHS Bassetlaw CCG and co-chair of the NHS Clinical Commissioners leadership group, told Pulse tier three services will not be in place in parts of Nottinghamshire until August next year, leaving GPs with nowhere to refer to.
Dr Kell told Pulse: ‘It’s a symptom of fragmentation – where one commissioner has a role without taking into account local variation.
‘We are asking for flexibility in the policy while tier three is still being commissioned. There are already very strict criteria regarding access to bariatric surgery. If there is one national specialised commissioning policy there should also be an equitable national service – at the moment it is effectively a postcode lottery.’
In London, City and Hackney CCG said patients had been barred from referral to the local specialist bariatric surgery service at Homerton Hospital, because their existing weight management services did not meet the new specification.
A City and Hackney CCG spokesperson told Pulse it had asked NHS England for an interim solution to make the pathway available to patients again until the issue is resolved.
He said: ‘Homerton, our local hospital, has a six month intensive programme for patients considering bariatric surgery. From 1 April, NHS England would not recognise this service as meeting the national specification.
‘We need to judge the benefit to our patients of funding a tier three service alongside other plans we have to improve services. There is some controversy about whether a tier three service does help patients lose weight as bariatric surgery is a better option for some patients.
‘NHS City and Hackney CCG asked to discuss this issue with NHS England, and met them in July 2013. We suggested that NHS England continue with the locally clinically agreed model for bariatric surgery while the issue was resolved. NHS England are (we understand) currently reviewing patients in the system and we expect that to be completed early next year.’
But neighbouring Tower Hamlets CCG, which also refers patients to Homerton Hospital for surgery, does have tier one to three services available.
Dr Sam Everington, chair of Tower Hamlets CCG and GP in the borough, told Pulse: ‘This is, though, a good example of the problems that develop when commissioning of a pathway, done previously by the PCT, is split between public health, CCGs, tertiary and primary care commissioners.
‘I think everyone accepts that we need to find a way of bringing all the commissioners together again to provide seemless commissioning of health services for patients.’
A spokesperson for NHS England said they were aware of the problem and had set up a working group to look at it.
She said: ‘A working group was set up earlier this year with the support and involvement of key partners including CCGs, local authorities, the Department of Health, Public Health England, and NICE.
‘The group is looking in detail at the wider issues around the commissioning of obesity services but is particularly focusing on the pathway to specialist obesity surgery. The working group will make a set of collective recommendations so that together we can deliver real system wide improvements.’