•
The individual is committed to the need for follow-up by a doctor and
long-term compliance with an altered lifestyle and dietary habit postoperatively.
Clearly there is a potential to create a perverse incentive to fail a weight
management programme as a route to bariatric surgery. In view of this,
referrers should be able to clearly identify the causes of failure and
comment on any likely impact these factors may have on enduring postoperative
weight loss and compliance with an altered lifestyle and dietary
habit.
Surgery should only be offered if:
•
The above criteria are met to the satisfaction of the patient’s GP and/or
Specialist Medical Obesity Clinic, the PCT responsible for the patient and
the provider of the surgery;
•
The person (and their family if appropriate) with severe obesity has
discussed in detail with the clinician responsible for their treatment (that
is, the hospital specialist and/or bariatric surgeon) the potential benefits
and longer-term implications of surgery, as well as the associated risks,
including complications and perioperative mortality;
•
The patient has realistic expectations of the outcomes of surgery, and
understands that long-term commitment and dietary compliance is
required;
•
The patient understands that cosmetic plastic procedures to remove
excess skin folds will be at the discretion of their local PCT and that local
criteria may apply to access such interventions. It should be noted that
following surgery, maximum weight loss occurs one to two years after
the procedure;
•
The provider of the service has undertaken a comprehensive, multidisciplinary
assessment of the individual; and arrangements have been
made for appropriate healthcare professionals (e.g. a psychologist or
appropriately supported, supervised and trained nurse with experience of
cognitive behavioural therapies (CBT)) to provide pre-operative and
postoperative counselling and support to the individual.
•
The choice of intervention is made jointly with the person, taking into
account:
- the degree of obesity.
- co-morbidities.
- evidence on short term and long term outcomes of Bariatric surgery.
- different techniques available and their relative efficacy.
- facilities and equipment available.
- experience of the surgeon who would perform the
operation.
- compliance with post-operative follow up and dietary
requirements.
The decision at the end of the day lies with the patient who should be
provided with all the relevant facts.
Bariatric surgery is recommended as a first line option for adults with:
•
a BMI of 50 kg/m2 or greater in the absence of co-morbidity.
•
A BMI of 45kg/m2 or greater in the presence of serious co-morbidity
which may be amenable to treatment if obesity is modified by surgery.
These conditions include:
- Type II diabetes, especially severe, uncontrolled diabetes;
- Severe obstructive sleep apnoea and obesity hypoventilation
syndrome;
- Obesity related cardiomyopathy;
- Clinically unmanageable hypertension;
- Established coronary heart disease; for example a history of
myocardial infarction in the past 6 months;
- Cerebrovascular pathology, for example a history of transient
ischaemic attacks or stroke (if good functional recovery) in the past
6 months;
- Obesity related pulmonary hypertension;
- Other co-morbid conditions which have been agreed by the PCT as
exceptional, for example Pickwickian syndrome, on an individual
patient basis; and/or
•
a condition which requires surgery at the same time as bariatric surgery,
based upon clinical need and urgency for such surgery (e.g. hernia
repair, cholecystectomy or severe gall bladder disease);
•
a condition which needs surgery or complex technological intervention as
soon as possible after bariatric surgery (e.g. hip or knee replacements).
•
a condition for which surgery is withheld until weight loss is achieved
(e.g. spinal pathology or awaiting IVF for infertility).
•
a condition that although surgically treatable is at high risk of recurrence
in the presence of obesity (e.g. incisional hernia).
Only referrals meeting these criteria should be funded by the NHS. No
referrals outside of this process will be approved, including direct GP or
consultant-to-consultant referrals.
NHS Central Lancashire will consider requests for surgery in regard to
patients who meet the NICE criteria but fall outside of the priority groups
referred to above.
When you write your appeal, refer directly to any of the above that apply to you and quote it as being from their Bariatric surgery policy.
Also in the letter, clearly write what attempts you have already made at losing weight and how many times you have lost and gained more each time.
In the meantime also ask if your GP can refer you for sleep study tests to see if you have sleep apnoea. If you do this is a reason to have surgery. Also have you had tests for diabeties, thyroid at all? if not then ask for them also.
I see you are in Preston but from what I can gather, it is central lancashire pct who do the bariatric funding.
Also, is it your gp who has applied for the funding on your behalf or have you already been referred to a surgeon and been seen?
If your gp has applied for funding maybe you can try it another way by asking him to refer you to a baraitric or upper gastro intestinal consultant direct.
Wishing you all the best, have a good ole weep, sleep then get up tomorrow with your battle boots on girl and get writing.
