Exclusive: Obese patients denied surgery by NHS rationing

NHS England is imposing restrictions to bariatric surgery that go beyond NICE guidance, GPonline can reveal.

Obesity: NHS Constitution guarantee on access to surgery ignored
Obesity: NHS Constitution guarantee on access to surgery ignored

GP leaders slammed the ‘rationing’ of NHS services and warned that the restrictions on access to care appeared to breach the NHS Constitution.

NHS England’s national commissioning criteria for bariatric surgery could prevent GPs from referring patients for bariatric surgery in line with NICE guidance.

The NICE clinical guideline Obesity: Identification, assessment and management of overweight and obesity in children, young people and adults was issued in November 2014.

Obesity surgery limit

It recommends bariatric surgery as a treatment option for patients with obesity if they ‘have a BMI of 40kg/m2 or more’ or a BMI ‘between 35kg/m2 and 40kg/m2 and other significant disease’.

It adds that ‘all appropriate non-surgical measures have been tried’ and the patient ‘has been receiving or will receive’ intensive management in a 'tier three' service.

The NICE guidance does not impose any time restrictions on access to care.

But NHS England’s commissioning policy stipulates that the patient must have ‘received and complied’ with a tier three or four weight-loss management service ‘for a duration of 12-24 months’ in order to qualify for bariatric surgery.

It also dictates that the patient must have been morbidly obese – BMI 40 or higher – ‘for at least five years’ to be eligible for the potentially lifesaving treatment.

NHS Constitution breached 

GPC deputy chairman Dr Richard Vautrey said: ‘Such restrictions appear to flout the NHS Constitution, which gives patients a right to receive NICE recommended treatments.

‘Many patients in this situation will find it hard to understand why a national body is picking and choosing the recommendations they follow without being explicit, open and transparent about it.

‘Many locally commissioned weight loss services don't see people for as long as 12-24 months so it would be impossible for such patients to qualify for surgery in these circumstances.

‘We know that rationing decisions are made all the time but patients want that to be done openly and not with pseudo-clinical reasons to justify these decisions.’

NHS England’s Clinical Commissioning Policy on Complex and Specialised Obesity Surgery says: ‘Bariatric surgery is recommended by NICE as a first-line option for adults with a BMI of more than 50kg/m2, in whom surgical intervention is considered appropriate. However, it will be required that these patients also fulfil the criteria below.’ It then lists the criteria, including the added restrictions.

NHS England did not respond to requests for comment from GPonline by the time of publication.

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