NHS Funding for Surgery - Where To Start?

[Mini]

If you are new to seeking surgery on the NHS, there are a few bits of information that you might find useful.

Firstly, you need to know which PCT (Primary Care Trust) you come under. If you are not sure, call your GP's surgery and ask.

If you are in England, most of the PCT's are listed on the BOSPA website. http://www.bospa.org/information.aspx?page=46

Most PCT's follow NICE guidelines, which are as follows -

http://www.nice.org.uk/guidance/inde...folder&o=30362

http://www.nice.org.uk/guidance/inde...r=true&o=32418

BMI of 40 or above, or 35 - 40 with co-morbidities.

To calculate your BMI, you can visit the NHS Calculator. http://www.nhs.uk/Tools/Pages/Health...ator.aspx?Tag=

If you think you qualify, the first place to start is to visit your GP and ask to be referred for funding. If you are unsure, you can contact your local PCT (google PCT and Name to find website) or local PALS office (Patient Advice and Liaison Service) and ask for clarification on your PCT's referral criteria. These contacts can also be used to clarify the referral process if your GP is unsure/unhelpful.

From there on, all PCTs operate differently. Some will require referral to a surgeon for assessment for suitability prior to funding application, some will require referral to a weight management service or bariatric co-ordinator, and some will require the GP to apply for funding first.

When funding is applied for, it will be considered by a panel as part of the PCT.

The process from GP to surgery varies hugely from one PCT to another, and the timescale can take anything from 2 months to 2 years, or longer.

You can read people's stories in the surgery diaries which form part of this section, but please try not to compare of be put off by those who have had lengthy battles or refusals for funding, as every case is treated differently.

 

[charliegirl]

Thanks for putting everything in the one place I am sure it will really help new comers.....xx

 

[gingernutter]

well done, thats very helpful info.

 

[hopelesscase]

fantastic post mini.

 

[bridiegeorge]

Thanks very much, there is quite a difference in waiting time. i hope my pct is a quick one!

 

[helen144]

Thanks Shell for putting that information on there, it has helped me alot in what to put in my letter to the PCTx

 

[djbp98]

Thanks Mini. I've been waiting since January '08 for approval from PCT. Was refused because my GP wouldn't give them more personal information, but then I appealed and was sent to see an Endocronologist who has said YES and am now waiting to see a Dietician before seeing surgeon at Taunton.

 

[brett30]

i guess i was lucky it only took 3 weeks for my pct to say yes to my funding ... but what ever the time hold in there and it will happen x

 

[katdec21]

Hi all,
The thing i have learnt with the PCT and the hospital appointments after, is patience, have lots of it. It has taken me a long time having first being refused then having it accepted after the critira changed, Then comes the appointments with the consultant, dietician and nurse specialist and trying to convince complete strangers that you are willing and ready to change. Now I understand that they HAVE to be sure that they are doing this expensive surgery to someone who will look after it and respect what it's supposed to do, but it is hard work!! I'm not trying to scare anyone off as i would do it all over again if i had to as i feel it is my only option to become the person i want to be (and have to be)

I have just been given my date for the endosopy for 10th feb which i am excited about as i see it as another step closer, if that goes well (which i hope it does) then i will need to wait for the surgery date, which i'm hoping won't be long after that!!

So to finish, and what i'm basically saying is have patience and alot of it cos at the end what else have you got? and I believe it will be well worth it.
So good luck to everyone going though the NHS and show them you can do it!

 

[size102b]

Hi do we have to write to the PCT or our GPS? x

 

[tesmaralda]

Hi do we have to write to the PCT or our GPS? x

Hi you should book an appointment and go and see your gp in person. It would be a goos idea to be informed of your pct funding criteria and also the NICE guidelines and take a copy of them with you to your gp appointment as a lot of drs are unaware of the process and criterias if they have not reffered anyone before. It also helps if yohave researched a little bit about the ops and what they entail and the implications of what having the op means to you afterwards.

If you have any more questions just shout up, you may be better off starting a new thread for your questions.

 

[size102b]

Hi you should book an appointment and go and see your gp in person. It would be a goos idea to be informed of your pct funding criteria and also the NICE guidelines and take a copy of them with you to your gp appointment as a lot of drs are unaware of the process and criterias if they have not reffered anyone before. It also helps if yohave researched a little bit about the ops and what they entail and the implications of what having the op means to you afterwards.

If you have any more questions just shout up, you may be better off starting a new thread for your questions.

Hi Thanks alot my GP didnt even want to consent me going onto Lighterlife????
I will have to print a load of stuff off my PCT is saying Nice guidelines which say NO REMIT what does that mean?x

 

[shelbell]

If your PCT says NICE guidelines then if your stats on the left are right then you qualify atleast for referral/application. If your GP is refusing can you see another GP in the practice? At the end of the day he has no right to refuse a referral.

 

[tesmaralda]

I have got this off the BOSPA website

HampshireBMI over 60 or over 45 with serious comorbidities such as established ischaemic heart disease, type 2 diabetes requiring oral medication or insulin, life-threatening sleep apnoea, severe uncontrolled hypertension, benign intracranial hypertension, history of transient ischaemic attacks or stroke, severe lower limb major joint disease requiring orthopaedic intervention which is precluded on safety grounds due to the patient’s BMI.

by the look of things hampshire pct is one of the hard ones to get funding from.

 

[tesmaralda]

Have Got this document saved on my hard drive but here are the NICE guidelines if this helps

1.1.1.1 Bariatric surgery is recommended as a treatment option for people with obesity if all of the following criteria are fulfilled:
· they have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved if they lost weight
· all appropriate non-surgical measures have been tried but have failed to achieve or maintain adequate, clinically beneficial weight loss for at least 6 months
· the person has been receiving or will receive intensive management in a specialist obesity service
· the person is generally fit for anaesthesia and surgery
· the person commits to the need for long-term follow-up.

1.1.1.1 In addition to the criteria listed in 1.2.6.1, bariatric surgery is also recommended as a first-line option (instead of lifestyle interventions or drug treatment) for adults with a BMI of more than 50 kg/m2 in whom surgical intervention is considered appropriate.
1.1.1.2 In people for whom surgery is recommended as a first-line option, orlistat or sibutramine can be used to maintain or reduce weight before surgery if it is considered that the waiting time for surgery is excessive.

The implementation tools for this guideline have information about more sources of information, particularly for professional groups. They are available from http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11000http://www.nice.org.uk/CG043

This document is dated December 2006 but is still current. I can't always find it when I go to the nice website. Hope this helps.


I have amazed myself the link above takes you to the page where you can select different formats to save to your computer the bit above is taken from page 53.

 

[voluptuouschick]

What a brilliant helpful post! it will help lots of people who like me at the beginning didn't have a clue!
xxxxx

 

[shell_1974]

Hi All....
Im from Salford, Manchester - I'm having to have monthly appointments with my weight management clinic for 6mth.
End of june 09, she said i will be refered to my local hospital to see the consultant and councellor, and take it from there.....
I asked her if i dont manage to loose any weight during those 6mth, will they refuse me the Bypass??? She assures me they are looking for either stability in my weight or for me to loose a little - i wont be forfeited for not loosing.
I was refered from my practice nurse to attend the weight management clinic, i'd previously tried loosing weight seeing her once a month - with no success!!
I will keep a diary as and when i get the operation.
Keep loosing all......

 

[angelrosy67]

Have faith, I'm from Cornwall too, I saw the surgeon in February and now have my date for op xx

 

[SacredSilence]

Can anyone tell me what the guidelines are for a TT please?

I can only find reference to bypass/band surgery which isn`t what I need

I live in Surrey which apparently comes under NICE guidelines - But I don`t know what they are?

Any help appreciated, Thanks x

 

[shelbell]

Have a look here - http://www.minimins.com/advice-plas.../67625-your-pct-its-position-tummy-tucks.html