Intended for healthcare professionals

Rapid response to:

Clinical Review

Surgery for obesity in adulthood

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3402 (Published 22 September 2009) Cite this as: BMJ 2009;339:b3402

Rapid Response:

Funding not available for NICE recommended treatments!

Dear Sir,

I read with interest your review of Surgical Treatments for obesity
in adulthood. I was interested to read that "In the United Kingdom,
funding for bariatric surgery must be applied for on an individual patient
basis from the primary care trust, which must apply the NICE guidelines in
its selection process". My experience is that this is not happening in
practice.

In my work as a General Practitioner I have been supporting a young
patient with morbid obesity and associated depression. With involvement of
secondary care psychiatry and specialised dietician services she is doing
a little better, but in spite of this intensive input her BMI remains very
high at 54+. We therefore discussed with the patient and her partner
referral for consideration of gastric banding or other bariatric surgery,
knowing that she met the NICE guidance for referral. She welcomed the
possibility of having bariatric surgery, and knowing that she met the NICE
criteria we did not foresee any problem referring her to our local
services. However, when I contacted the Local Health Board (LHB) to
inquire about the local referral process I was shocked and very upset to
then discover that the LHB is not honouring the criteria for bariatric
surgery that are stated by NICE. Several other criteria are added so that
my patient would not qualify, even if her BMI were to rise to 60 or 70
kg/m2; she would not qualify unless she had other conditions such as
hypertension uncontrollable by multiple medications by secondary care,
uncontrollable diabetes, etc. I was then left with the difficult task of
telling my patient this news. Perhaps I had been naive in assuming that
services were being offered in line with NICE guidance (though the authors
of the BMJ review stated themselves that bariatric surgery MUST be funded
in line the the NICE guidance), but I would never have offered the
possibility of referral to my already vulnerable patient had I realised
that the funding is NOT being offered as recommended by NICE.

Unfortunately I suspect that I am not alone in my inability to refer
patients for this cost-effective intervention in line with
recommendations.

Yours faithfully,

Dr Nicola Jones

Competing interests:
None declared

Editorial note
The patient whose case is described has given signed informed consent to publication.

Competing interests: No competing interests

01 October 2009
Nicola D Jones
General Practitioner on the Doctors' Retainer Scheme
Roseneath Medical Practice, Padeswood Road, Buckley, Flintshire CH7 2JL