Post Bariatric Surgery Follow-up Monitoring [Private and NHS Procedures]

Written: 03rd December 2024

I am writing to all colleagues regarding this aspect of follow-up care for patients. The LMC has been in correspondence with your ICB regarding this issue.

The British Obesity and Metabolic Society Guidance mirrors NICE guidance (CG189) and the latter states:

1.11 Follow-up care

1.11.1

Offer people who have had bariatric surgery a follow-up care package for a minimum of 2 years within the bariatric service. This should include:

monitoring nutritional intake (including protein and vitamins) and mineral deficiencies
monitoring for comorbidities
medication review
dietary and nutritional assessment, advice and support
physical activity advice and support
psychological support tailored to the individual
information about professionally led or peer-support groups. [2014]

1.11.2

After discharge from bariatric surgery service follow up, ensure that all people are offered at least annual monitoring of nutritional status and appropriate supplementation according to need following bariatric surgery, as part of a shared care model of chronic disease management. [2014]

The first two years of follow-up following bariatric surgery should remain within the bariatric surgery service, and that, following this, discharge to General Practice should be under a Shared Care Agreement [SCA] or equivalent model of shared care.

For NHS care , the evidence available to the LMC is that bariatric surgery centres in the UK do follow-up such patients for two years, but that no Locally Commissioned Service exists to support a SCA subsequently.

If GP colleagues receive a letter saying such a patient is discharged for such follow-up, the LMC recommends practices respond in line with Template Letter A.

The situation with private bariatric surgery is significantly more difficult but all ICBs have confirmed to the LMC that it is inappropriate for General Practice colleagues to pick up follow-up arrangements for bariatric surgery post-operative follow-ups.

The LMC therefore recommneds:

If patients consult regarding intended privately funded bariatric surgery, aside from the general advice that as an NHS GP you may offer, you should inform the patient that they will need to arrange follow-up privately for two years. This should be documented in their notes.

Obviously not all patients inform their NHS GP prior to having such private surgery, whether in the UK or abroad, but if you subsequently discover this has occurred you should give and document this advice.

If patients state they cannot arrange such private follow-up, you should refer the patient to the local NHS bariatric centre. The LMC recommend appending Statement Template B to the referral letter.
GPs remain responsible for the routine and emergency essential care of patients, including any NHS referral if appropriate for any illness that might be a consequence of the bariatric surgery, for example, to gastroenterology or ED.

Practices who up to now have been undertaking follow-up monitoring of such patients despite there being no local commissioning arrangements to support this may wish, under the BMAs Collective Action, to give notice to the ICB on this work. If so, the LMC recommends a three month Notice period is given. A Template Letter C is enclosed to facilitate this.

I hope this background is helpful.

Dr Julius Parker, Chief Executive