Bariatric Surgery (Tier 4)

(Weight Loss Surgery)

Threshold

Bariatric surgery is a treatment for appropriate, selected patients with severe and complex obesity that has not responded to all other non-invasive therapies. Within these patient groups bariatric surgery has been shown to be highly cost effective.

Bariatric surgery is recommended by NICE as a first-line option for adults with a BMI of more than 50kg/m2, in whom surgical intervention is considered appropriate. However, it will be required that these patients also fulfil the criteria below. Selection criteria of patients for bariatric surgery should prevent perverse incentives for example patients should not become more eligible for surgery by increasing their body weight. Similarly the selection criteria should not forbid bariatric surgery for patients who have lost weight with non-surgical methods.

Surgery will only be considered as a treatment option for people with morbid obesity providing ALL of the following criteria are fulfilled. NB. If patients meet these criteria, GPs can now refer direct to Bariatric Surgery providers:

The individual is considered morbidly obese, e.g. for the purpose of this policy:

• BMI of 40kg/m2 or more,
• or between 35 kg/m2 and 40kg/m2 or greater in the presence of other significant diseases. 
• Patient is aged 18 or above
• Morbid/severe obesity has been present for at least five years.
• Patients must have been referred to local tier 3 weight management programmes:
• for formalised MDT led processes for the screening of co-morbidities and the detection of other significant diseases. These should include identification, diagnosis, severity/complexity assessment, risk stratification/scoring and appropriate specialist referral for medical management, and;
• recently received and complied with a local specialist obesity service weight loss programme (i.e. local tier 3 weight management programmes), and;
• been unable to lose clinically significant weight (i.e. enough to modify co-morbidities) during the period of intervention. Patients who lose sufficient weight to fall beneath the NICE guidance should not be considered appropriate for surgery.

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for this intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.

Post-Operative Cosmetic Procedures

NOTE: All patients undergoing bariatric surgery, as part of their informed consent must be advised that ICBs will not fund post-operative cosmetic procedures arising from weight loss.

New/Novel Procedures

Any new/novel obesity surgery procedures outside of a policy will not be routinely commissioned. Where a clinician wishes to make a request for a new device/procedure, an application for exceptional funding through the Norfolk and Waveney Integrated Care Board (ICB) Individual Funding Request (IFR) process should be made in the first instance. The latter should be free to seek advice from the CRG leads (the later forum will be replaced by an Expert Clinical Group)

Source: NHS England Guidance for ICB Clinical Guidance: Surgery for Severe and Complex Obesity – APPENDIX 7

Revision Procedures

Revision procedures will be covered by separate guidance.

Source: NHS England Guidance for ICB Clinical Guidance: Surgery for Severe and Complex Obesity – APPENDIX 8

Patients who have had the surgery privately. If a GP or Consultant requests follow-up care for a patient at an NHS provider after having the surgery privately, the NHS ICB Individual Funding Request process should be followed.