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Applying for NHS Funding for Bariatric Surgery

For the most part health care services provided through the NHS have historically been, and still are, excellent. In fact you would be hard pressed to find anyone who could make a contrary argument. 

However, what is not so excellent is the ordeal of getting approval for your bariatric surgery from NHS, since the process involves first going to your GP, getting them to sign on, applying to your local Primary Care Trust (PCT) for approval of your surgery (which could take months) and then – if you have been approved and if the PCT did not add any stipulations – getting on the NHS weight loss surgery waiting list.

How to Get Weight Loss Surgery on the NHS

Before your PCT can approve your request you will need to meet certain weight loss surgery NHS criteria. While bariatric surgery NHS criteria can vary from location to location in the UK the National Institute for Health and Care Excellence (NICE) guidelines recommend free weight loss surgery on the NHS should be approved if:

    • You have a BMI (Body Mass Index) over 40 or a BMI of 35 to 40 with other serious conditions that would likely improve if you had this type of surgery.
    • You have tried repeatedly to lose weight using other methods but have been unsuccessful.
    • You are willing to commit to a long term program of healthy eating and other lifestyle changes.
    • Your level of overall fitness is sufficient to undergo surgery and endure general anaesthesia.
    • You have been or are willing to receive treatment from a team of obesity specialist.
  • Or your Body Mass Index is over 50.

[su_note note_color=”#EAF8FF” text_color=”#000000″]If you currently suffer from Type II diabetes and are of South Asian descent in particular bariatric surgery NHS guidelines allow you to be considered for surgery even if your Body Mass Index is below the standard threshold of 35.[/su_note]

Bariatric Surgery NHS Funding: The Approval Process

If you believe you qualify for NHS funding of your weight loss surgery you will need to pay a visit to your GP and ask him or her to provide you with a referral in order to get the process started. If you are uncertain exactly what the referral criteria are for your local PCT do an Internet search for “PCT” plus your location to find the website of your local PCT. They will have the criteria for bariatric surgery on NHS there for you to see. Or you can go to the website of your local Patient Advice and Liaison Service (PALS). In addition these websites will have information that will help you clarify the referral process in the unlikely event your GP is uncertain how to proceed.

The bottom line is that bariatric surgery NHS waiting times vary because all PCTs are slightly different in the way they handle referrals. In some cases they will require referral to a weight management service before they will approve funding, others will require the referral comes from a surgeon and still others will insist the referral come from a bariatric coordinator.

The amount of time involved from your initial consultation with a GP to actual surgery (provided you are approved by the PCT panel) can range from 2 months to more than 2 years. There is simply no way to predict it with any accuracy.

Can I Get Weight Loss Surgery on the NHS if I Go Abroad?

One thing few people are aware of is that obtaining funding to have different types of surgery abroad is not only possible, it’s fairly easy and could actually wind up saving you a lot of time. The main stipulation is that you are only allowed to have the procedure done within what is known as the European Economic Area or EEA. The EEA consists of all EU member states plus Liechtenstein, Norway, Iceland and Switzerland. The bottom line however is that, as long as you meet weight loss surgery on the NHS criteria, you can have the surgery performed abroad, within the EEA.

What Treatments Will NHS Pay for Abroad?

The EU Cross Border Healthcare Directive gives you the right to access treatment within the EEA as long as the treatment is medically necessary and would otherwise normally be funded by the NHS. While it is uncertain as of this writing how the British exit from the EU will affect this right to have your surgery abroad it is nonetheless a right that remains in place for the time being and one you should seriously consider taking advantage of.

Under the EU Cross Border Healthcare Directive purely cosmetic surgery or cosmetic dentistry you have performed abroad is not eligible. Only, as we state above, those procedures that are deemed “medically necessary”. Also, the determination as to whether something is medically necessary cannot be made by the foreign healthcare professional but must instead be made by the GP or specialist in the UK.

What Are the Mechanisms for Having Surgery Abroad Paid for by NHS?

You have 2 potential funding routes when it comes to having weight loss surgery abroad. They are S2 (the “Social Route”) or Article 56 (the “Entitlement Route”).

  • With the S2 Social Route you are able to have treatments covered by NHS that are typically funded in the UK. S2 amounts to a direct agreement between the UK government and the health service of the country where you’ll have your surgery performed. With S2 you make no payment yourself and you may be covered for costs that would exceed costs incurred in the UK for similar services.
  • Article 56 is a program whereby the NHS will reimburse you for the cost of any qualifying procedure you had abroad in an EEA country whether it was performed by a state funded or private healthcare provider. In some instances you will need pre-authorisation for Article 56 reimbursements. Note that, although the program will ‘only’ reimburse for the cost of an equivalent procedure in the UK, weight loss surgery in a country like Latvia is far less expensive than in the UK and so full reimbursement should not be an issue.

The major difference between the 2 programs then is that with S2 there is no upfront payment on your part, but you will have more flexibility when it comes to choosing a practitioner with Article 56.

Are These Programs Available to Everyone?

You will need to meet certain criteria for weight loss surgery on the NHS in order to have your surgery abroad paid for.

    • You must be a resident of the UK who is eligible for UK social security services.
    • You can only go abroad for treatment if the trip will not endanger your health.
  • Purely cosmetic treatments are not eligible.

The Healthcare Commissioner’s office and your local health board retain the right to refuse compensation for treatments they deem unnecessary or inappropriate. If they determine your proposed weight loss surgery on NHS to be ineligible you have a right to appeal their decision.

Types of Weight Loss Surgery Covered

The NHS will typically cover the cost of several types of weight loss surgery including:

    • Gastric bypass – Wherein a pouch is created out of the topmost portion of the stomach and the intestine rerouted to connect directly to this new, smaller stomach. With gastric bypass you are unable to eat as much as before and don’t absorb as many calories from the food you do eat.
    • Sleeve gastrectomy – Most of the stomach is physically removed. Again you cannot eat as much as before. However, with this type of surgery there is no rerouting of the intestine.
  • Gastric band – A band is wrapped around the stomach near the top dividing the stomach into two sections. The small upper section restricts how much you are able to eat as with other bariatric surgeries. But there is no cutting of the stomach or intestine.

Each one of these procedures will typically lead to drastic weight loss in fairly short order and each has its benefits and risks.

Should You Simply Go Ahead and Have Your Surgery in Latvia or Wait for the NHS?

Just imagine: you are grossly overweight and repeated attempts at dieting have all failed. You are suffering wild swings in your blood sugar levels, your sleep apnea is causing major problems with alertness and has you scared you’re going to die from it like Carrie Fisher did, all the excess weight is causing problems with your knees and ankle joints and you’re also dealing with soft tissue infections caused by your skin rubbing against itself. You’re at your wits end but you’ve heard you could get bariatric surgery on the NHS… 18 weeks after the PTC have approved you, which could take many months. (It’s also possible the PTC may identify other issues they want you to address before undergoing weight loss surgery in the UK on NHS.) So you could be looking at a wait of a year or possible 2 (perhaps more) before you finally are allowed to have your weight loss surgery on the NHS in the UK.

A Faster, Better Way

With the Article 56 ‘entitlement’ route it might be easier and better to simply head to Riga and have the surgery at the Weight Loss Riga Clinic, pay for the surgery out of your own pocket since the price is so reasonable, and then apply for reimbursement when you return to the UK. You may have to get prior approval for this type of procedure from NHS but that typically only takes about 3 weeks from the time you submit the application. Once approval is granted for weight loss surgery by NHS you can head to Riga for your surgery and apply for reimbursement on your return as we said. Handling your surgery this way could drastically reduce your waiting time from a year or more to a few weeks with no loss in the quality of the final product.

How reasonable are costs at Weight Loss Riga? Have a look at this comparison chart which shows the price for weight loss surgery in a variety of different European capitals.

Price for gastric bypass in various European cities:

[ninja_tables id=”387″]

As you can see your out of pocket expenses to have the surgery performed at Weight Loss Riga are less than half what the surgery would cost in London or Dublin. Therefore, paying for the procedure yourself is not nearly the financial stretch it would be in the UK. And as long as you meet NHS weight loss surgery criteria and have received prior approval you can get fully reimbursed once you return home.

The Bottom Line

When it comes to weight loss surgery NHS will pay as long as it is not being done for purely cosmetic reasons. As far as where you have the procedure done you have a choice of either staying in the UK and waiting for your case to work its way through the Byzantine NHS approval process or traveling abroad, having the procedure done without delay in a state of the art facility like Weight Loss Riga, and being reimbursed when you return home. While there is no doubt the bariatric surgery NHS/England route will result in the procedure being done right can you really afford to wait one or two years?

The decision is ultimately up to you. But be fully aware that as long as you meet certain NHS bariatric surgery criteria you have options before deciding to wait in line for the NHS. If you have questions about how to get weight loss surgery on the NHS call our UK patient coordinator today.