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GPs told they can decline private bariatric surgery aftercare requests

GPs told they can decline private bariatric surgery aftercare requests

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

An increasing number of patients who have undertaken private bariatric surgery abroad are requesting follow-up care from their GPs, local medical leaders warned.

Lancashire and Cumbria LMCs have developed a template letter, which it said was agreed with the local ICB, for GPs to send to such patients advising them that their practice is not funded to provide this service.

Patients are going abroad for bariatric surgery because NHS waiting lists are ‘ridiculously long’ and it is cheaper than private care in the UK, according to the LMC chief operating officer Faye Tomlinson. 

Earlier this month, Rotherham LMC created a similar template letter for local GPs which said ‘it is not the responsibility of a general practice to provide follow-up to private surgery which has been carried out abroad’.

Other local leaders have recently raised the same issue, with Cambridgeshire LMC creating a guidance document in June which said patients undertaking private bariatric surgery abroad was an ‘increasingly common scenario’.

It emphasised that routine follow-up services are not provided on the NHS to these patients and they should seek a private follow-up programme in the UK for a two-year period.

And in Somerset, the LMC has formed a working group on the private care interface, which includes bariatric surgery undertaken abroad, and has also put out a survey asking GPs how many aftercare requests they have received ‘in order to have conversations with the ICB on how these patients are managed in the future’.

Lancashire and Cumbria LMCs’ template letter reassures patients that while aftercare is ‘not routinely commissioned by Lancashire and South Cumbria ICB’, NHS emergency services will be available if any issues requiring emergency treatment arise following the surgery. 

LMC chief Ms Tomlinson said the number of requests relating to bariatric surgery aftercare has risen over the ‘past couple of years’, and the LMC consortium decided to build the letter due to lots of GPs raising concerns about having to deal with this demand. 

While these kinds of requests, that are outside the remit of GPs’ core work, can increase workload, Ms Tomlinson said the main concern is around patient safety. 

She said: ‘It’s not only about the funding, it’s also about the specialist care that they need that [GPs] can’t provide, that potentially should be provided by a specialist from secondary care.’

Lancashire and South Cumbria ICB, who agreed the letter, has confirmed it is ‘in accordance with BMA guidance’ and ‘GPs will be following appropriate advice agreed nationally’.

An ICB spokesperson told Pulse: ‘Any emergency care will still be provided by the NHS, but the letter is referring to routine aftercare, which includes blood monitoring and prescriptions for nutritional supplements that can be obtained privately in a planned way.’

On the possibility of patients deteriorating due to not receiving aftercare, they said: ‘Of course, any deterioration may present as a non-specific illness, and may not necessarily be due to the procedure, so the patient would be assessed and treated as needed.’

Rotherham LMC said in a recent newsletter that it is ‘extremely frustrating’ that no progress had been made on this issue despite raising it with the integrated care system (ICS).

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It said: ‘We are aware of the growing number of cases presented to practices, many of whom would not have qualified for NHS bariatric surgery.

‘Once again, the lack of appetite within the [South Yorkshire] ICS to properly support GP practices leaves practices with a very difficult dilemma, with each practice being left to decide individually how to manage their response to patient requests for follow-up.

‘It is not the responsibility of practices to provide the routine necessary follow up of these patients and so patients should be encouraged to find a UK private provider to take over care for the first 2 years post operatively.’

The LMC did however emphasise that although practices do not have the commissioned funding or the ‘expertise’ to provide follow up care, they should still provide general medical services if patients develop complications from their surgery.

Medical Protection Society (MPS) case manager Julie Baylis has said that ‘with more patients travelling abroad for weight loss surgery, it is no surprise that GPs are facing an influx of follow-up monitoring requests and are uncertain of their responsibilities.’

The Medical Defence Union (MDU) advised last year that ‘a GP without the support of a UK-based bariatric specialist could struggle to justify why they took on monitoring for a complex patient if something went wrong’.

It added: ‘Patients entitled to NHS treatment can switch from private treatment to NHS care as long as that treatment is supported by the NHS.

‘However, many patients who opt for surgery abroad do so because they don’t meet the criteria for bariatric surgery funded by the NHS, meaning they may not qualify for NHS funded bariatric follow-up care.’

In these cases, the MDU advised GPs to check with their local commissioner and confirm decisions in writing, so that if patients are directed to self-funded aftercare, the GP ‘can demonstrate that they did explore the options for NHS care’.

This echoes BMA guidance, which said patients have a right under the NHS Constitution to transfer care from private to NHS, but that if the aftercare is ‘of a specialist nature, or not within normal general practice remit, the patient should be referred to the appropriate service in the UK for this follow up’.

The guidance added: ‘If an appropriate service is not available, or rejects the referral, this should be directed to the local commissioner whose responsibility it is to commission the service.’

The Department of Health and Social Care (DHSC) referred Pulse to section 1 of the National Health Service Act 2006 which says the NHS must provide comprehensive health services that are free of charge, and emphasised that patients should not lose their right to access NHS services by going private.

Bariatric, or weight loss, surgery is available to patients on certain conditions, such as having a BMI of 40 or more, and agreeing to long-term follow-up after surgery. 

If going private, the NHS recommends that patients speak to their GP for advice in the first instance, and it warns that having treatment abroad can have risks around the accessibility and standard of aftercare. 

Earlier this year, local GP leaders at the UK LMCs conference called for practices to be remunerated appropriately for requests from private healthcare or insurance providers relating to their patients. 

And last year, figures from the Private Healthcare Information Network showed that many more patients are now opting to pay for operations privately out of their own money than before the pandemic, with some areas seeing numbers more than double.


          

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READERS' COMMENTS [19]

Please note, only GPs are permitted to add comments to articles

Not on your Nelly 6 September, 2023 1:08 pm

There was never any doubt about this. Good to see it writing this. We can’t continue to be the risk sink for lack of specialists services.

David Church 6 September, 2023 2:57 pm

Except that we can’t, can we?
They are Registered with us for their care, and nobody else will accept a referral.
Only if GPs are allowed to charge a fee to their NHS patients, or de-register them for not paying it, can we ever decline such care provision in practice – becasue GMC and LHB will say we must provide all care needed.
And will probably hold us to account for failing to meet the expected standards of the relevant specialist as well.

David Church 6 September, 2023 2:59 pm

what about de-registering all patients at the airport/ferryport, and only re-registering them after re-vetting to see if we want to?
We would not be discriminating on any protected characteristics, only on whether they have pre-arranged suitable follow-up of their medical condition with a relevant local specialist!

Not on your Nelly 6 September, 2023 3:27 pm

You are wrong David Church. Just read what is written in the whole article above . You are not a specialist in bariatric medicine. You don’t know what blood tests are required, when they are required, and what to do with them when they come back abnormal. Would you do an appendix in-house if there was no commissioned hospital service? Probably not?

SUBHASH BHATT 6 September, 2023 3:51 pm

It is not as simple as that. We need to deal with what ever symptoms they have. Unless you see patient and investigate, you don’t know if they are related to surgery. Gps know what blood test are required and what supplements are needed because they do see their own patients who had bariatric surgery on nhs.
Secondary care send you details of what to do. Same applies to these patients as well.
Seeking treatment from private care reduces nhs work load. These are patients who do pay taxes and you can’t treat them differently.
Sooner or later one would be caught in breech of their terms of service. . I agree it does increase work load.

Slobber Dog 6 September, 2023 8:18 pm

Fantastic.
How exactly does this help patients?

Wendy Domleo 6 September, 2023 9:01 pm

https://bomss.org/gp-hub/
This site has excellent clear guidance & there is an audit tool from the RCGP which gives clear guidance to support good post bariatric care

This is arguably less work than looking after (yet another) diabetic.

Waseem Jerjes 6 September, 2023 9:56 pm

My guess that the Lancashire and Cumbria LMCs do not have any medics on its board or they chose to forget that doctors have a duty of care when a patient (or anyone on their behalf) makes contact. This is shocking news ….

Dr No 6 September, 2023 10:07 pm

What a stupid decision, it’s a piece of piss doing this monitoring and prescribing supplements if indicated, all the necessary info is out there, you just need to know what the procedure was. Another anti-patient decision. Seems like we’re often taking out our frustrations on our patients when we should be taking the fight to the government. It’s a dreadful look – somebody forks out to improve their health and we say no, we won’t help their aftercare. Great. And since profanity is now du-jour with government ministers, here’s one more from me. Fuck the Tories.

Mr Marvellous 7 September, 2023 9:35 am

I’m perplexed by some of the responses above.

We have a contract and it doesn’t include undertaking this kind of follow up. Most GP surgeries are at (or over) capacity and are struggling to keep up with demand for contracted work.

So undertaking this kind of activity means NOT doing something else that you should be doing.

If you’re sitting there with nothing to do, by all means undertake this work on a pro-bono basis. Your staff, your money, your choice. We certainly won’t be.

James Cuthbertson 7 September, 2023 2:22 pm

The patient is happy to pay the private surgeon but is not prepared to budget for the aftercare, and would prefer their GP did this for free.

Dr No 7 September, 2023 2:59 pm

I would suggest instead of disengaging from patient care we disengage from any activity that is not directly related to clinical care. The list is too long to detail of course but would include appraisal, revalidation, NHSE diktat, PCNs and the endless managerialist meetings endemic in modern primary care. We are very poorly represented as GPs. I think our “leaders” have developed Stockholm Syndrome by working too closely with the enemy, Agreeing and negotiating contracts that facilitate all this crap that mitigates against patient care makes them complicit.

Just Your Average Joe 7 September, 2023 4:02 pm

Urgent referral to hospital bariatric clinic.

Job done as Hospitals get infinite resources and government supports their budgets.

We aren’t paid or contacted to do private follow up care.

Dave Haddock 7 September, 2023 4:45 pm

Dear Dr No,
Fuck Labour for inflicting on us the crock of shit that is the NHS, and resisting any attempt to replace it with something that might actually work.

Slobber Dog 7 September, 2023 6:21 pm

Private bariatric surgery (performed in uk)
Saves the NHS at least £12000 per patient.
GPs. -The profession that likes to say ‘no’.

Michael Green 7 September, 2023 9:18 pm

Eat less and move more?

Steven Berg 9 September, 2023 8:24 am

Yes, its not rocket science arranging the blood tests and supplements, and bully for those very large patients who have undoubtedly spent years trying ineffectively to do it the natural, hard, way and have plucked up the courage and the funds to go abroad and save time on the waiting list and the poor NHS a bucketful of dosh. I have no problem giving my time, thought and NHS support to those with an open hand and heart – BUT – what about the youngish patient who has a BMI of 27 who goes to Turkey because her friends are all thinner than her and some unscrupulous surgeon does the gastric bypass – should the NHS put money and time into her aftercare when she wouldn’t have even qualified for a referral to Slimming World.?

James Weems 11 September, 2023 9:44 am

Steven. You’re being selective in your idea over who qualifies for follow up. Surely best to stick to our contract and not take things on that we really aren’t set up to provide.

Steven Berg 11 September, 2023 2:01 pm

I agree, James, that we are not ‘set up’ for it and maybe not really qualified to provide it – as for so many other of the demands in Primary Care, but in my 47 years as a GP I have , as I am sure you and the vast, vast majority of our colleagues have, tried my best to be kind, considerate and caring – and help to the best of my ability whenever I can.