Post-Bariatric Surgery Follow-up Monitoring (NHS and Private Procedures)

Updated guidance on follow-up responsibilities for patients post-bariatric surgery, including those who underwent private procedures. Reflects NICE NG246 and outlines appropriate GP responses, with template letters for use.

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Post-Bariatric Surgery Follow-up Monitoring

This page provides updated guidance for general practices on the issue of follow-up care for patients who have undergone bariatric surgery, including both NHS and privately funded procedures.

We are aware that some ICBs and hospital providers are discharging patients to general practice for follow-up without a formal shared care arrangement in place. We hope this page provides clarity and reassurance on what is and is not expected of GPs.

National Guidance

NICE guideline NG246 states that:

  • For a minimum of two years following surgery, patients should receive structured follow-up within the bariatric service.
  • After discharge from the surgical service, patients should be offered annual monitoring of nutritional status and appropriate supplementation as part of a shared care model of chronic disease management.

This is echoed by the British Obesity and Metabolic Surgery Society (BOMSS), and remains the position supported by SSLMCs.

Local Context

In all our ICB areas, there is currently no commissioned Shared Care Agreement (SCA) or equivalent to support the ongoing follow-up of these patients in general practice once they are discharged from secondary care.

However, a new Locally Commissioned Service (LCS) for post-bariatric surgery follow-up is due to commence from 1 October 2025. We will update this page with the specification and commissioning details once published by the relevant ICBs.

Until that LCS is in place, our advice remains as follows:

LMC Recommendations

  • For NHS procedures, patients should not be discharged to general practice for follow-up unless an appropriate shared care arrangement is in place. If this occurs, we recommend using Template Letter A to respond.
  • For private bariatric procedures (including those undertaken abroad), patients should be advised:
    • That they are expected to make private arrangements for follow-up care for at least two years.
    • If they are unable to do so, they may be referred to the local NHS bariatric service, accompanied by Statement Template B.
  • Practices who are currently undertaking uncommissioned follow-up may choose to give notice to the ICB under the BMA’s collective action framework. We advise a three-month notice period, using Template Letter C.

Please note:

GPs remain responsible for essential NHS care, including any appropriate referrals arising from complications or comorbidities (e.g. to gastroenterology or emergency departments).