What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

The British Obesity & Metabolic Surgery Society is concerned at the number of patients experiencing complications after bariatric surgery performed outside the UK. We have had increasing admissions to Royal Bournemouth Hospital (10 in the past 12 months) and complications have been life threatening. Outcomes have included intensive care admissions, prolonged enteral feeding, and further surgery.

Bariatric care in the UK is securely regulated via monitoring and inspection by the Care Quality Commission (CQC). When people opt to go abroad, there is no legal redress for aftercare, leaving patients no other option than to seek help from the NHS upon repatriation.

Improving the knowledge of health professionals regarding weight management pathways and post-operative management will reduce the delay in waiting to see specialist bariatric health professionals for guidance. By discovering the reasons for opting to have bariatric surgery abroad, there is scope to improve pathways and reduce bariatric tourism.

What does your project aim to achieve?

We will:
1. Identify what influences individuals to seek bariatric surgery abroad
2. Identify the key barriers in primary and secondary care to accessing bariatric surgery
3. Provide education to primary care to help develop and improve the weight management pathway
Current bariatric pathways are complex for patients in primary and secondary care. Patients are referred onto a tiered pathway which is time restrictive and result dependent, reducing access to effective weight management services.
The UK has one of the lowest operation rates in Europe despite evidence of its cost effectiveness. The project will aim to tackle the crucial issues with implementing accessible pathways for weight management. Health care professionals can avoid weight management conversations due to a limited understanding about obesity, inadequate weight documentation, time constraints or lacking resources to raise weight management conversations.

How will the project be delivered?

The project will be led by the Bariatric Team at Royal Bournemouth Hospital. Questionnaires will be sent to all patients within the tier 4 bariatric service to explore what would be / have been their reasons for pursuing surgery abroad. Further work will be done with 73 GP practices in Dorset to explore knowledge regarding the weight management pathway and care post bariatric surgery.
Based on responses and analysis, appropriate education sessions from the Bariatric team will be offered to GP practices to target barriers / gaps in the weight management pathway. Furthermore, education on post-operative care will aim to reduce the need to seek expert guidance and further appointment costs for those repatriated from abroad.
Interviews will be conducted with patients who have had complications following surgery abroad. Through the form of private social media channels, there will be guidance to our patients regarding the dangers of bariatric tourism.

How is your project going to share learning?

We will also aim to share experiences and guidance regarding bariatric tourism to patients considering bariatric surgery to raise awareness of the dangers / complications that can arise. This can easily and quickly be built into a wider awareness campaign which could be led by NHS England across the country.

The current pathway may cause confusion and delay to patients accessing appropriate weight management services which in turn increases the risk of bariatric tourism.  This in turn increases the risk of unforeseen complications, and emergency treatment for bariatric tourists.

We will help primary care providers to identify any stigmatised views, training, time barriers and misinformation to enable informative counsel to patients, including collaboratively working with the ICB, Primary Care, Secondary Care and stakeholders in developing a clear patient centred pathway. We can then share this wider with other areas as an exemplar.