Information For Patients Post Bariatric (weight loss) Surgery outside the NHS
Many people are disappointed with wait times and availability of NHS weight loss treatments. There are various clinics providing access to private, surgical treatments in the UK and overseas. The NHS has no way of ensuring these treatments are safe, individually suitable or performed by reputable practitioners. Any private course of treatment should include the whole package, i.e., pre-assessment and counselling, surgery and follow up. For weight loss surgery, this is recommended for at least 2 years following surgery. This is to ensure the surgery has no complications and that your weight loss and nutrition is achieved and maintained safely.
Private, non-NHS providers often state a longer list of monitoring than is strictly necessary or available to NHS patients, even for NHS bariatric surgery. Endoscopes, ultrasounds, and several blood tests would fit into this category. This means, that even if the NHS were to take on post-operative care following your surgery, it would be at a level determined by the NHS.
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We will:
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Do reasonable blood tests to ensure that you remain well. These blood tests are the same blood test we would offer any other patient who came to see us. For example, full blood count, kidney function, diabetes checks, lipids (cholesterol), bone tests, vitamin d if appropriate liver tests, b12 folate and iron levels
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Refer you for emergency care with a surgeon if needed
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Provide you with medications we think are appropriate to keep you well – especially if those medication need a prescription – such as B12 injections, iron and calcium tablets
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We are being approached regularly to provide follow up for surgeries which have taken place in the private sector or abroad. As GPs we have neither the knowledge nor time to do this follow up. We have therefore produced this document to be clear about what we will do and what we will not do.
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We will not:
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Arrange routine ultrasound scans
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Arrange endoscopes to assess the surgery
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Do blood tests that are outside the scope of usual NHS general practice – including selenium, copper, zinc, magnesium
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Treat you to super high levels of vitamins and minerals – if that’s what your specialist recommends then they will need to provide the testing and treatment for that long term.
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Repeat routine blood tests according to a schedule is not usual NHS care
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Provide you with “recommended medicines” that are not part of usual NHS care – this includes vitamin tablets.
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All follow up for 2 years should be included in your UK private surgery package. After 2 years we will support you to stay well as above.
If your surgery has taken place abroad, we will refer you to the bariatric team at the hospital and they may be happy to take over your follow up care. If not, you will need to arrange private follow up with a surgical provider in the UK. We will try and help as above but we will not be able to provide you with the specialised follow up even if advised to.
Routine lifelong supplementation post bariatric surgery
Multivitamins and minerals. You should purchase a suitable over the counter daily multivitamin and minerals preparation that contains iron, selenium, copper (minimum of 2mg) and zinc (in the ratio of 5- 15mg of zinc for every 1mg copper). Some suitable over the counter options include TWO daily of Tesco Complete multivitamin and minerals or Lloyds Pharmacy A-Z multivitamin and minerals. These are not available on NHS prescription.
Vitamin B12 injections. Not all people need these after weight loss surgery. Gastric sleeve and gastric bypass surgery makes it harder for the body to produce and absorb the chemicals needed to help your body grab onto Vitamin B12. Hydroxocobalamin 1mg intramuscular injections every 3 months are the usual recommendation.
Calcium and vitamin D supplements may be advised.
You need to take all your multi-vitamin / mineral supplements that have been recommend, for life.
Blood monitoring. Bloods tests are largely checking whether you are taking enough multivitamins to give your body the nutrients it requires. This is not an NHS funded activity. If you are experiencing symptoms that might signal to your GP practice that you have a mineral or vitamin deficiency, there are some blood levels that they can check if necessary. If you are not taking your multivitamins, they will remind you to resume these. This leaflet does not replace follow up as described by your private specialist and included in your package. This information is for those who have presented to their GP having been misinformed by their private provider about NHS follow up.
If you suffer from constipation you may need to take a non-bulking agent such a Benefiber, Optifibre or Senna. Speak to your local pharmacist for a suitable non-bulking agent.
Your private provider may have suggested you need to have nutrition bloods taken at 3 months, 6 months, and 12 months then annually to monitor for any nutritional deficiencies. This is not currently funded by NHS, and you should ask your provider if this is covered in your package. Your GP will not provide this testing or analysis of results.