LLR Policy for Post-Operative Support for Self-Funded Bariatric Surgery

Bariatric surgery (weight loss surgery) is widely recognised as the most clinically and cost-effective treatment for individuals with severe and complex obesity. Post-operative care is essential to ensure patients receive appropriate lifelong monitoring, minimising the risk of nutritional deficiencies and other complications.

NHS Leicester, Leicestershire, and Rutland (LLR) acknowledge that some residents opt for privately funded bariatric surgery within the UK or abroad. This policy outlines the post-operative care available through the NHS following private treatment.

Key Considerations:

• • Patients do not have the automatic right to re-enter routine NHS care (from private care) at any time during an episode of care in this situation. Although NICE recommends specialist MDT follow up for two years following bariatric surgery this will not be routinely provided on the NHS for those patients who have self-funded their surgery and responsibility remains with the bariatric centre who performed the surgery.

• • Patients considering bariatric surgery abroad are strongly advised to consult their GP beforehand to understand the coordination and provision of aftercare.

• • Additional costs may be incurred for follow-up care and potential return visits to the private surgical provider.

• • The NHS provides guidance on medical treatment abroad:. https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/going-abroad-for-medical-treatment/

1. NICE Guidelines & Quality Standards

• • NICE guidance applies exclusively to NHS-commissioned services within the Tier 4 weight management service framework. Providers outside the UK do not adhere to these standards.

• • The British Obesity and Metabolic Surgery Society (BOMSS) advises that post-operative care should remain with the bariatric centre for at least two years post-surgery.

• • GP practices are not expected to provide or arrange follow-up care for privately funded procedures.

2. NHS Commissioning & Service Specification

• • As per NHS England’s 2016 guidance (Appendices 8 & 9), complications resulting solely from a privately funded procedure should be managed and funded by the private provider.

• • The only exception to this is when a patient is admitted under emergency care, or the complication is life threatening.

3. Emergency and Clinically Urgent Treatment

Patients who undergo private bariatric surgery and later present at an NHS facility in an emergency will receive NHS-funded treatment.  In addition, patients that have undergone complex procedures can be referred into secondary care this includes:

• • Mini Gastric Bypass (Single Anastomosis Gastric Bypass or OAGB)

• • Duodenal Switch

• • Biliopancreatic Diversion

• • Single Anastomosis Duodenal Switch (SADI)

• • Single Anastomosis Sleeve Ileal Bypass (SASI)

4. NHS Post-Surgery Care for Private Patients

• • Routine post-operative care for bariatric surgery performed abroad is not routinely commissioned by the NHS.

5. Eligibility for Limited NHS Follow-Up Care

• • Private patients seeking up to two years of follow-up care (e.g., band adjustments or routine outpatient reviews) must meet NHS eligibility criteria.

• • The patient, their GP, and the private provider must collaborate to provide evidence of:
    
    • • Attendance at a Weight Management Service, including Dietetics/Tier 3
    • • Fulfilment of recommended clinical criteria
    • • Details of the primary bariatric procedure
    • • Post-operative follow-up attendance and response to surgery

• • If eligibility is confirmed, the GP must submit a referral with supporting documentation to the relevant commissioned NHS service.

6. Exceptional Clinical Circumstances

• • If a patient does not fully meet eligibility criteria but demonstrates clinical exceptionality, a request can be submitted to the ICB under the LLR Prior Approvals process.

• • Applications must include clear evidence of clinical exceptionality and exceptional capacity to benefit. Requests should be sent to: lcr.ifr@nhs.net

7. NHS and Private Treatment Boundaries

• • Patients cannot selectively combine NHS and private treatment within a single episode of care.

• • NHS bariatric surgery and its associated pre-, peri-, and post-operative care are considered a single, integrated package provided by a Tier 4 multidisciplinary team.

• • If a patient opts for private surgery, the NHS will not assume responsibility for any ongoing treatment costs, including when:
    
    • • The patient cannot afford continued private treatment
    • • Private insurance does not cover the full cost
    • • The patient requests NHS-funded care based on treatment effectiveness

8. Patient Responsibilities Before Seeking Private Surgery Abroad

• • Patients are responsible for understanding aftercare arrangements before proceeding with private bariatric surgery.

• • Government, NHS, and patient support groups emphasise the importance of planning for post-operative care, including potential costs and travel requirements.

• • Patients may choose to purchase a standalone post-operative care package from a UK independent provider.

• • The NHS provides guidance on planning for treatment abroad:. https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/

• • Dietary advice and nutritional care are essential after bariatric surgery. University Hospitals of Leicester have produced a dietary advice guide for patients who have had private surgery, this can be accessed here https://yourhealth.leicestershospitals.nhs.uk/library/csi/dietetics/3787-dietary-advice-after-bariatric-surgery-for-patients-who-have-private-surgery

9. Importance of Tiered Weight Management Services

• • NICE guidelines on weight management emphasise a personalised approach to weight loss interventions, including bariatric surgery.

• • UK providers must meet stringent regulatory and professional standards, ensuring safe and effective treatment outcomes.

• • Surgical outcomes are monitored through a national bariatric database, and UK bariatric surgeons must undergo recognised training, certification, and maintain full professional insurance https://bomss.org/bomss-statement-on-bariatric-tourism-2/

Summary

• • GP practices are not expected to provide specialist aftercare for private bariatric surgery.

• • Patients must take responsibility for understanding the implications and ensuring aftercare arrangements before undergoing private surgery.

• • NHS-funded follow-up care is only available under specific circumstances:
    
    • • Patients on an NHS bariatric surgery waiting list at the time of private treatment may be eligible under section 5.
    • • Patients with exceptional clinical circumstances may be considered under section 6

• • Clinical exceptionality is rare and assessed on a case-by-case basis.

For further information, refer to the LLR ICB Individual Funding Requests Policy, available on our policies page. Healthcare and treatment policies – LLR ICB https://leicesterleicestershireandrutland.icb.nhs.uk/your-health/healthcare-and-treatment-policies/