What the guidance says / common practice
It is usual practice for patients who have such procedures via the NHS to be monitored by their provider / specialist for the first two years. Monitoring in this 2-year period includes blood profile (some of these tests are not available to general practice) and nutritional intake / lifestyle. The specialists (usually dietician and consultant) will support the patient with appropriate advice and identify any complications or problems that may arise during that time. Upon completion of the two years of monitoring they are then discharged back to the GP surgery for annual blood monitoring, to be done on or around the anniversary of the surgery. As a practice we would start monitoring from the 3rd anniversary of the procedure and every year thereafter.
Surgery Undertaken Privately
On the NHS pathway, the pre-op advice process is a year-long for good reason. Short term fixes that only provide the surgery are much less successful and the operation is only a part of the answer. Patients who have had surgery completed privately (abroad) are advised to seek bariatric follow up privately for the two years post procedure. (It is usual that any procedures undertaken privately in the UK would also include follow up as part of the package of treatment). It is important to understand that NHS bariatric services are not able to provide routine follow up to patients who had their surgery done privately. We can only refer patients back into NHS providers to manage emergencies.
What we steps we need to take as the GP
It is recommended that patients will need lifelong nutritional supplements (depending on the type of procedure carried out). The most immediate medical need for this group of patients is the recognition of complications such as late leaks or internal hernias. These present with continuous vomiting, dysphagia, intestinal obstruction, or severe abdominal pain and require emergency admission. The patient’s history should be flagged, and the bariatric team would see them and manage them acutely.
Before Surgery Is Done Privately
- When a patient advises they are considering surgery abroad, we recommend a consultation with a clinician in advance. (Patients should be aware of the risks and what they can and cannot expect from us after surgery. This means that we will deal with any acute problems that, we will carry out blood profiling every year from year three and prescribe appropriate nutritional supplements. We will not undertake routine monitoring in the first two years).
- Patients are advised to avoid pregnancy for at least 12-18 months post-surgery.
After Surgery
- When a patient advises us that they have had surgery abroad we will:
- Record and code that in the patient’s medical. This is necessary because it can influence what investigations need to be made when a patient presents with acute symptoms.
- Diary entries need to be added from year three and then be completed every year thereafter for blood profiling. We will encourage patient to attend for annual BMI and dietary / lifestyle advice.
- See urgently any complaint of: Continuous vomiting, dysphagia, intestinal obstruction (gastric bypass) or severe abdominal pain require emergency admission under the local surgical team.
- Prescribe nutritional supplements as per guidance and as indicated from testing.