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How is funding eligibility determined?

grizabelle

grizabelle

New Member
Hello,

Does anyone know exactly what factors are looked at before funding is approved or declined? How is the decision made to fund someone's surgery, do they look at all your medical records or is it largely contingent upon the GPs letter? Just curious. Although it's impossible to know until I have an actual appointment, I'm still fishing around here trying to find out why my funding was approved and what it means! I've had mixed feedback on this so far - some of you believe it means a lot, some believe it means very little until you've had an appointment and gotten actual feedback from the MDT.

(I've already written this in another post, so without wanting to bore everyone senseless with my details I'll mention that am pre-diabetic, have high BP and cholesterol, and being investigated for sleep apnea (diagnosed by my doctor but not by ENT yet, no sleep study).

Thanks for your contributions! It's great having a whole crowd to chat to. :D
 
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It is very frustrating isn't it? It would appear all areas differ and that within each area things have changed as guidelines have changed/waiting lists have increased - there seems to be so little information and everything behind closed doors which results in more waiting and more frustration!

Correct me if I am wrong but it would appear once you have been referred depending on your bmi and co-morbidities and pct you are either sent to tier 3 weight management programme for 6 - 12 months or straight to a group session followed by MDT day, meeting with surgeon and then you get your date, pre-op then finally the operation. I think most people are told if they are successful for funding at the MDT session but I could be wrong...

I will watch for your progress with interest! Good Luck!
 
thank-you so much yvonne! what you've said makes perfect sense except at the end where you've said people are told if they are successful for funding at the MDT session. I've already been told my funding is in place. In fact, my GP sounded very excited and said that with my sleep apnea as well, I could expect my appointment to come through within the next 2-3 months and the surgery done within one year. I haven't asked him how many others he's referred, but I do have my doubts now about his level of enthusiasm having been able to chat to you guys on this forum. He even talked about getting prepped for surgery and anaesthesia etc.

I guess I'll wait and see. I wonder if I'm one of those preventative diabetes surgeries. I had gestational diabetes in 2008 and it has pretty much returned now - I think around half of those with GB get it in later life, I must be one of them.. I'm also a carrier of muscular dystrophy with a leaky valve of no consequence but that they are worried will get worse with all the extra effort the heart has to make because of all the weight..

sorry rambling on - I guess I'll wait and see!

x
 
Yours does sound like a unique case so it wouldn't surprise me if you go straight through.

I'm just wondering - if you get your appt soon, what will you do between now and a years time? Hope it goes smoothly for you!
 
thanks Birdie. I appreciate that and I hope that you get yours soon too, or at least some confirmation of what's going to happen - it's difficult waiting and not having a clue. i don't get the part about a year's wait, either. Are GPs all generally "up" on this referral process and know what they're telling their patients? I don't know, I just feel as though he meant well or something but wasn't right about the timeframe.. I'm sure you know what i mean! it doesn't sound quite right. but anyway. back to wondering and waiting. did i see in another thread that you got a letter recently?
 
That's the thing - my GP (who might I add asked me if is thought about surgery before and has actually had the surgery herself and lost 11 Stone) also didn't know that the weight management was 1 year, when I went back and told her she was surprised and said she thought it was 3 months. She then tried to refer me directly to the hospital and was rejected saying I had to do the tier 3 thing. So no, I don't think they know even though they mean well.

Yes, I had a letter through to fill in a questionnaire and food diary to then send back and it says I'll then be sent an appointment for my MDT assessment. Before that I had a letter in the post to choose out of 11 hospitals where I wanted to go for the surgery. I chose Chichester - but I do wonder what other hospitals procedures would have been like! Lol!

I can't wait for Friday when I post off the form - judging by Harley's waiting time it was only a week after she posted her food diary back till she had a letter about the MDT assessment - which is the 19/9 so by my calculations my appt will be mid October or hopefully before then. Mind you I don't think I can have the MDT before I've been to warts and all seminar which is 26th Sept (booked in!) so probably October then!
 
do you have "co-morbs" (! not sure what i think of that abbreviation, do they really need a cute pet name?!) and if so may i ask what? i've already listed mine too many times.. i of course hope they mean i can get this done quicker. like i mentioned before, it's an odd feeling to be GLAD you have things that mean you might get treatment even earlier.. that's a bit of skewed thinking there but then again we're all desperate to not be overweight and headed in bad directions! ugh.
 
Hi Grizabelle
Tier 3 has been going since 2008, but Since April 2013 you could go to your Doctor, or download a form of the Internet for Tier 3 Weight Management. On this your BMI had to be over 50. Then this year in April it all changed to 4 Health where you have to do a 12 week sessions Dietitians etc, but now if you have medical issues you can get away with a BMI of 40 and it seems you only have to do the course for 6 months, otherwise its 12 / 24 months with no complication .

Since things have gone over to Tier 4, its got quite a few teething problems and to be honest the Doctors don't seem to know alot about what's happening.

Hi Birdie
Yes you have your Seminar, then its very quick to see the MDT Assessment.
Only thing with me, I went to the seminar, then saw Surgeon and now going later for my MDT Assessment. So you might get to the MDT quicker.
 
Well i am not sure which area you are from as it seems to be different everywhere.

I can only tell what happend with me.

I went to my gp to ask for referral for bariatric surgery back in november last year. I did my research about nice guidlines and what the criteria in my are is. (Which said if bmi is over 50 tier 4 can be consideted as first line treatment). My bmi was over 50, i was not diagnosed with anything then (though i didnt have my period for over 8 months by then).

So i was referred then.

Got a letter from my local ccg saying that funding for tier4 treatment is approved (dont know what that means..)

Then few weeks later i was contacted by the hospital i was referred to and was booked to see dietitian and consultant surgeon. My appointments with them were at the end of jan. i also filled in the questioneers i was asked to.

Then after the second appointment (the one with consultant surgeon) i was informed that now i have to wait until the team has they mdt meeting and discuss my case.

I had to wait for that until april (longer than 1 month they said as a timescale guidance).

After that mdt they decided i meed to see dietitian, bariatric nurse and medical obesity specialist.

While waiting for the mdt to discuss my case i felt worse and worse.. Also my period was still missing so i went to see gp about it one more time.. (I went to see different gp than usual). I was sent to do some blood tests (and repeated ones too) and i was diagnosed with pcos and diabetes and was put on metformin.

So when i saw dietitian again at the hospital.. I informed her about the news.. And i gave her the printouts with my blood test results.

Then i had my appointment with bariatric nurse. And one more month later i saw someone from endocrinology department(medical obesity specialist)

Then i was put back on the list for my case to be discussed on mdt meeting again.

This waiting was for around 6 weeks..

And then i got a call from hospital addmission department informing me i've got my surgery date.

So i am not even sure when my case was duscussed or when they put me in the waiting list for surgery.. Not sure if my new diagnoses if diabetes made things move.. Or my 14kg i've lost since jan.. Or maybe it would have happened even without any of this..

So now i am having my pre op assesment this week and surgery in the beg of september..



Hope your journey will be smooth and not too long! Good luck.
 
Hi Llora
Well said. :D
Yes with the new guide lines, you would have got through with your diabetes.

Good luck with your surgery, and all the best with your journey.
 
i thought with a bmi over 50 or over 45 with co-morbidities you missed the weight management program? Does this differ from place to place too?
 
Willow4 said:
Hi Llora
Well said. :D
Yes with the new guide lines, you would have got through with your diabetes.

Good luck with your surgery, and all the best with your journey.
Click to expand...

I am not sure what new guidelines everyone keep referring to.(when did they come in action) As on july during my last appointment at the hospital i was reassured there were no new guidelines (in my hospital/area)

I still think its confusing., and the patients are left in the dark too much. The whole process is very secret and very different everywhere :)
 
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After a few months of being in limbo ( due to nobody knowing what was happening with the new guidelines) I'm now under my chosen hospital. I don't have to do any course. I've been given my target weight to lose and the next time I'll be seen is in 3 months time by the bariatric nurse. I was told that you have to be under the hospital for at least six months before surgery
 
Hi Yvonne
While you are doing the weight management course, you are still seeing the WLS team. After the 12 weeks course, you still see the dietitian every 3 month for a year, plus after care after your operation.

Since this April everyone as to do the course, its only if you have co-morbilities you get there quicker, and the BMI gone from 50 to 40.
 
Blondie43 said:
After a few months of being in limbo ( due to nobody knowing what was happening with the new guidelines) I'm now under my chosen hospital. I don't have to do any course. I've been given my target weight to lose and the next time I'll be seen is in 3 months time by the bariatric nurse. I was told that you have to be under the hospital for at least six months before surgery
Click to expand...

I may be reading other peoples posts wrong but I think there are some people who have had an initial appt with a consultant and then a MDT meeting then within the 16 weeks waiting time have had or had a date scheduled for surgery? Although writing that down I imagine that could easily total 6 months, but do you think it's a minimum of 6 months (is that due to there waiting time?)

Thanks!
 
HI Yvonne
Yes its due to waiting time, so every hospital I should imagine will be different.
But if you have co-morbidities, you get there quicker.
 
I met my surgeon whilst I was having an endoscopy ( nothing to do with wls) and he was telling me about how things have changed at his hospital and what I needed to do to get referred there, as I was originally told they weren't accepting new referrals. I've had my first seminar and my next appointment is in 3 months, I see no one in between. Also we were told all the professionals meet at the mdt meetings every Monday to discuss patients, but patients do not go to these, as far as I'm aware!
 
Willow4 said:
HI Yvonne
Yes its due to waiting time, so every hospital I should imagine will be different.
But if you have co-morbidities, you get there quicker.
Click to expand...

Willow4 said:
Hi Yvonne
While you are doing the weight management course, you are still seeing the WLS team. After the 12 weeks course, you still see the dietitian every 3 month for a year, plus after care after your operation.

Since this April everyone as to do the course, its only if you have co-morbilities you get there quicker, and the BMI gone from 50 to 40.
Click to expand...

I'm sorry - this is a late night for me so I'm not understanding!
If you have co-mobidities you miss the the weight management? But if you have any bmi even over 50 and no co-morbidities you have to do a year weight management then, plus 6 months at the hospital before surgery? or before they agree to starting the process for surgery?

Sorry to be so dim, I just cant get my head around everyone's experiences being so different!! Aren't we all paying into the same pot?!!
 
My BMI is over 50, I don't have to do any weight management programme, but I do have to lose my weight loss target set. I've still to get final approval for the op. I can't have it any sooner than 6 months from my initial seminar, as you have to be under the hospital for at least 6 months now (new rules)

Hope this is clearer!
 
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