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 our area there is currently no universally commissioned Shared Care Agreement (SCA) or equivalent arrangement covering post-bariatric surgery follow-up across all ICBs and localities served by Surrey and Sussex LMCs.

A Locally Commissioned Service (LCS) for post-bariatric surgery follow-up was introduced from 1 October 2025 in Sussex. Local implementation remains at an early stage and arrangements vary between localities. At the time of review there has been no implementation within Surrey and no equivalent programme identified within Kingston & Richmond. Practices should refer to their local commissioning guidance for current arrangements. The principles set out below remain relevant where follow-up responsibilities have not been formally commissioned.

Until a commissioned service is in place in your area, 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).