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CCGs not commissioning weight loss programmes, surgeons warn

Royal College of Surgeons says that a postcode lottery is developing in obesity treatment

Ingrid Torjesen

Monday, 06 January 2014

Patients are being denied access to bariatric surgery because intensive weight loss programmes, which are a prerequisite to surgery, are not being commissioned in some areas, the Royal College of Surgeons and the British Obesity and Metabolic Surgery Society has warned.

Last year, NHS England, which is responsible for commissioning bariatric surgery, published a clinical commissioning policy on the specialised management of severe and complex obesity.

The policy reflects NICE guidance, which recommends individuals have tried and exhausted all non-invasive treatment options prior to potentially higher-risk surgical approaches. As part of this, it requires patients to complete support from weight management services (called ‘tier 3’ support) which helps them to succeed in controlling their diet post-surgery.

Recent Hospital Episodes Statistics data shows there was a 10% fall in the number of bariatric surgical procedures performed between April 2012 and March 2013, even though obesity in England has continued to rise.

The Royal College of Surgeons is concerned that the current problems with commissioning weight management has led to a further fall in the number of bariatric procedures, as these programmes are a prerequisite for referral to bariatric surgery.

The Royal College of Surgeons and British Obesity and Metabolic Surgery Society, in collaboration with other partners including the Royal College of Physicians, has produced NICE accredited commissioning guidance for weight assessment and management programmes. The guidance is intended to assist clinical commissioning groups in commissioning these services and reduce variation in access to these clinics across the country. This guidance is due for publication at the beginning of this year.

Professor Norman Williams, President of the Royal College of Surgeons, said: “To hear that a postcode lottery is emerging in UK weight management provision is deeply worrying. The fact that access to surgery is blocked because of this means the NHS is simply storing up problems for later and compromising patient care. The Royal College of Surgeons and Specialty Associations’ commissioning guides give commissioners a clear understanding of what cost-effective quality care should look like. We hope to work with CCGs to reduce this sort of variation and drive up standards of patient care across the UK.”

Richard Welbourn, president of the British Obesity and Metabolic Surgery Society, said: “It is concerning that patients are being denied access to treatment due to weight assessment and management clinics not being commissioned. The benefits of bariatric surgery are well-known. It leads to greater body weight loss and higher remission rates of type 2 diabetes than non-surgical treatment of obesity. Poor access to bariatric surgery therefore places some patients at continuing health risk. In the long run this will end up costing the NHS more.”

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