Editorial: The postcode lottery is alive and well

Bariatric surgery is a hugely effective treatment for individuals who are seriously overweight - both in terms of clinical outcomes and cost-effectiveness.

NICE backs surgery as first-line treatment in people with a BMI over 50 and says it can be used in those with a BMI over 40 (or 35 if the patient has weight-related health problems) if other interventions have failed.

However, a number of PCTs in England are ignoring this recommendation, and the body of evidence that supports bariatric surgery, by restricting it to patients with a BMI over 50 who have diabetes or severe sleep apnoea.

Around half of all patients who are obese have diabetes or pre-diabetes, but the other half face having to wait until they develop the condition, or it gets worse, before they are allowed potentially life-saving surgery.

The restrictions are no doubt aimed at saving money but, as GP has said before, this is a false economy. Patients who develop diabetes after being denied surgery will cost the NHS significantly more than if they had a gastric band or bypass operation sooner.

This also raises questions over the role of NICE guidance. NICE was established to make evidence-based decisions, taking into account cost, that could be applied across the NHS. This was supposed to end the postcode lottery of healthcare provision.

There have been major steps forward in this area, and there are moves to strengthen this further. Under the NHS Constitution, part of the Health Bill going through parliament, NHS organisations will be legally obliged to provide treatments recommended in NICE's technology appraisals.

However, clinical guidelines, under which bariatric surgery for obesity falls, remain recommendations. PCTs are not legally required to follow them, even if they reflect best practice.

For obese patients, these PCTs' decision to restrict surgery is unfair - and flies in the face of evidence-based medicine. What is the point of having national guidance for PCTs, if they choose to ignore it? The postcode lottery, it seems, is alive and well after all.

Read more opinion from the GP editorial team in the editor's blog

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