Bariatric surgery, including procedures such as gastric bypass, sleeve gastrectomy, and gastric banding, is a highly specialised intervention requiring lifelong monitoring and support. Despite the growing number of patients undergoing these procedures, there is currently no commissioned NHS service for the routine aftercare of patients who have had bariatric surgery, whether performed within the NHS, privately, or abroad. This leaves general practice in a difficult position: responsible for patient safety, yet not resourced or contracted to deliver the level of care these patients require.
General practice must be clear about its role and limitations. We are not specialists in bariatric care, nor are we commissioned to deliver structured follow-up or nutritional surveillance. Long-term management of patients who have had bariatric surgery should remain with the surgical or bariatric team responsible for the procedure, particularly in the absence of a commissioned community-based pathway. However, GPs do retain a duty to prevent foreseeable harm and provide basic medical support where necessary.
At a minimum, practices should ensure that the surgery and date are clearly documented in the patient’s medical record. Hospital discharge summaries should be reviewed, filed, and any short-term follow-up actions—such as medication adjustments or blood tests requested within the first few weeks—should be actioned if no other provider is managing them.
Where a patient is already under follow-up by a specialist team, practices can provide routine blood tests as requested, though interpretation of these results and management of any abnormalities should be directed by the specialist. Repeat prescriptions for supplements or medications may be issued if they have been initiated by a reliable source and there is clarity regarding the dosing and duration. However, initiation or titration of supplements without clear specialist advice should be avoided.
Patients presenting with complications or symptoms suggestive of post-operative issues should be assessed and treated as any other clinical presentation would be. However, where follow-up, interpretation, or management requires specialist input, patients should be signposted back to their surgical or bariatric care provider. Practices should make clear in correspondence and documentation that they are not providing specialist bariatric aftercare.
General practice is not responsible for managing the nutritional consequences of bariatric surgery, initiating or monitoring vitamin and mineral replacement, or offering structured psychological or weight management support related to the surgery. We should not be expected to provide ongoing clinical follow-up for these patients without a commissioned service and associated funding. Attempts to shift long-term responsibility to general practice should be resisted in the interests of patient safety and service sustainability.
An increasing number of patients are undergoing bariatric procedures abroad, often with little to no handover to UK services. In these cases, GPs should exercise additional caution. When a patient presents following surgery overseas, the practice should document the type and date of the surgery, and note where it was performed. Any immediate post-operative complications should be managed appropriately, as with any acute clinical presentation.
However, GPs are not obliged to take over long-term follow-up or prescribing from providers abroad. The responsibility for aftercare remains with the service that performed the procedure. Patients should be clearly advised that follow-up must continue with the overseas provider or with a private bariatric specialist in the UK. If blood tests are requested due to specific symptoms or safety concerns, these may be offered at the discretion of the clinician, but should not be routine or ongoing without a formal plan in place.
It is essential to document clearly that the surgery was not NHS-commissioned, and that the patient has been advised to seek specialist follow-up elsewhere. This protects both the clinician and the practice from assuming inappropriate clinical responsibility.
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