Editorial: Commissioners face bariatric surgery lottery

The BBC's news led last week with the story that the number of people in England undergoing surgery on the NHS to help them lose weight has increased 10-fold in less than a decade.

This week's GP looks at the issue from a different perspective and exclusively reveals that data obtained under the Freedom of Information Act show large regional variation in the number of weight-loss procedures.

It is the very definition of 'postcode lottery', with a 143-fold variation between the largest and smallest number of bariatric operations per primary care organisation (PCO).

In the past, such stories would have provided ammunition to fire at PCOs for not following clinical guidance from either NICE or SIGN.

But the impending abolition of PCTs means that, all too soon, GP commissioners will be faced with the funding headaches that were once reserved for managers.

How to react?

'It is a steep learning curve and there are many new skills to be learned - but my advice is not to feel overwhelmed.'

Those are the words of a clinical director in north-east London, where GP commissioning has been operational since last spring, writing in this week's Letters page.

It's a great read, looking at both the pros and cons of commissioning but also accepting the inevitability of change.

He adds: 'I understand it can be an intimidating prospect but one that shouldn't stop us meeting the great opportunity GP-led commissioning presents to both clinicians and patients.'

And that, surely, is the key.

The GPC is right to warn that consortia will not be able to afford increased provision because of a lack of resources, leaving them open to legal challenges.

More detail is certainly needed about the implications of the NHS Constitution and exactly what rights it bestows patients.

But commissioning also represents an undeniable opportunity for GPs to prove their value to the NHS and its patients.

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