Most GPs and practice nurses see patients with overseas surgery complications

Exclusive Three quarters of UK GPs and practice nurses have seen patients with complications from having surgery overseas in the past year, a Pulse and Nursing in Practice survey has found.

The survey of more than 1,500 GPs and practice nurses asked how many patients they had seen who have suffered health problems as a result of a surgical or cosmetic procedure carried out abroad.

Some 74% said they had seen at least one such case in the past year. Around a quarter of all respondents reported seeing between two and nine patients with post-surgical complications after having a procedure overseas.

Complications from gastric bypass and other bariatric surgery were most commonly seen, according to survey respondents, with patients also presenting with problems after having liposuction, tummy tuck and other cosmetic procedures.

A GP based in the northwest of England said: ‘I have seen at least two to three patients a year with post overseas surgery complications. Breast issues usually were concerned with infection or wound dehiscence but sometimes asymmetry and implant issues.

‘I had a gastric band patient who ended up in ICU vomiting, with severe electrolyte disturbance. These were the worrying ones – no supplements, no follow up bloods, no discharge letters or plans.’

And one GPwSI in weight loss recalled several ‘absolute horror stories’ where patients had undergone weight-loss surgery abroad.

She said: ‘I had a patient years ago who had the cuts but didn’t lose any weight at all, and I strongly suspect they didn’t actually do the operation. It’s horrifying.’

Many GPs told Pulse that Turkey was the most popular destination for surgery of all kinds.

‘I’ve seen significant complications relating to cosmetic procedures in Turkey – there is shocking post-op care, poor patient education and poor discharge communication,’ one GP said.

Dr Ross Cunningham, a GP in Enfield, north London, said: ‘You hear about people going to Turkey and getting a package holiday included with their surgery. Or they’ll come back and there’s no paperwork or reports, so we don’t know what they’ve had done. Sometimes they don’t even know what they’ve had done.’

He added: ‘I’ve had a patient who is on methadone with opioid addiction, and she’s got chronic pain and lots of other problems. She would never be declared fit to go under elective bariatric surgery in the UK. But she went to Turkey for a gastric bypass, then came back to us with terrible reflux.’

Wait times and eligibility criteria for NHS bariatric surgery mean desperate patients choose to fly abroad instead and this often leaves GPs to pick up the pieces, survey respondents said.

Dr Kate Hodges, a GP near Durham, said she empathises with patients. ‘Many say they’re going abroad for surgery because either it’s not available on the NHS – like breast reduction where BMI is more than 27 – or where there are very long waiting times,’ she said, adding that post-op complications are ‘a big challenge’.

‘Patients expect for this to be dealt with in the NHS but local services are significantly stretched,’ she said. 

Dr Lee Sanders-Crook, a GP based in Stafford, said that on occasion, staff are expected to provide follow-up care beyond their scope of practice.

He said: ‘A particular case involved requests for a practice nurse to remove sutures from facial surgery, close to the eyes, which far exceed the simple wound care covered under our local enhanced service contract.’

He added that his practice has a ‘clear policy’ highlighting it does not offer post op care for private surgical procedures including those done abroad,’ but he added that he believes the NHS should support those who experience problems afterwards.

He added: ‘I think patients who get surgery abroad should be entitled to NHS follow up. But that does not mean just returning home, expecting the NHS to pick up the pieces.

‘Transfer of care should be agreed between responsible parties, and in the case of planned or elective surgery I can see no reason this cannot be done pre-operatively.

‘However, facilitating a system that allows queues and waiting lists to be surpassed sets a dangerous precedent.’

Another GP highlighted that bariatric surgery in particular is a very specialist discipline and follow-up requires expertise, leaving GPs unsure how to manage post-op patients.

‘There are some very real risks as far as vitamin and mineral deficiencies go – iron, vitamin D, B12, folate, magnesium – and all of that needs checking frequently in the beginning and then once a year at least for life,’ she said. ‘But patients will hit the doorstep of the GP, and the GP says, “I don’t know what to do about this”.’

One GP told Pulse that NHS-funded aftercare should be off limits. ‘I strongly feel that patients having treatment abroad, especially cosmetic, should not receive any subsequent treatment at NHS expense,’ they said. ‘They should only be able to access treatment privately if required.’

Local medical committees have previously told GP practices they can decline patient requests for routine aftercare in the first two years after private bariatric surgery undertaken abroad.

And Pulse revealed last week that patients across England are being prevented from receiving life-saving operations because strict NHS rules mean they cannot be prescribed GLP-1 weight-loss medications such as Mounjaro (tirzepatide).