• Clinicians raise concerns with Jeremy Hunt after survey finds two thirds of CCGs have taken no action to prepare for transfer of obesity surgery commissioning
  • Only 12 per cent of CCGs aware of post-surgery “follow up protocols”. Lack of follow up can be fatal
  • Transfer delayed for a second time

The government has been warned that clinical commissioning groups are not adequately prepared for a major transfer of commissioning responsibilities.

A group of clinicians sent a letter to the health secretary after a survey of CCGs in November found 66 per cent had taken no action to prepare to take over commissioning responsibility for obesity surgery from NHS England.



CCGs were supposed to take over commissioning obesity surgery in 2015

The transfer was due to take place in April but NHS England now says it will happen on a CCG by CCG basis “during 2016-17”.

NHS England is responsible for commissioning obesity surgery such as gastric bands and gastric bypasses, but it wants to hand the responsibility to CCGs.

The national commissioner believes if CCGs are responsible for more of the obesity pathway they will be able to save money by directing funding “upstream” to help patients lose weight before costly surgery becomes necessary.

The transfer was supposed to take place in April 2015 but was delayed for a year following warnings that a lack of preparation would put patients at risk.

However a survey has revealed a continued lack of preparedness and confusion about the transfer among CCGs.

In October and November, the Transition Coalition – a group of obesity clinicians – surveyed CCGs on what progress had been made to prepare for the transfer.

Receiving responses from about a third of CCGs, they found 66 per cent had undertaken no preparation for the transfer, and 52 per cent had no idea how many patients had obesity surgery in their area in the last two years.

Perhaps the greatest concern was the lack of knowledge about post-surgery follow up, which is vital to patient safety.

Fifty per cent of respondents did not commission follow up, and a further 25 per cent did not know whether they did. Only 12 per cent were aware of post-surgical follow up protocols.

The survey prompted the coalition to send a letter to Jeremy Hunt last month raising concerns that CCGs’ lacked the expertise to “commission these complex services safely”.

“The virtual absence of knowledge in relation to post-surgical follow-up is especially alarming as inadequate provision can prove fatal,” it added.

While the letter called for the transfer to be halted because it was “unsafe to proceed”, Professor John Wass, chair of the coalition, told HSJ he had received additional assurances from NHS England which meant he was “not worried now about safety”.

However, Professor Wass said there was still a “significant lack of preparedness”.

He also raised concern that a poorly managed transfer could further reduce the number of obesity operations, which was already “declining”.

“Our numbers of… operations are not as many as in France, and we have a far higher prevalence of obesity than France does,” he said.

“NICE guidelines suggest that there should be more patients being operated on because it is cost effective and saves NHS funds.”

NHS England told HSJ the transfer would not take place in April, as previously stated by the government, but would happen “during 2016-17”.

“The actual date of transfer will be determined between NHS England and the relevant CCG,” a spokeswoman said.

“This is a transfer of commissioning responsibility and the normal governance arrangements will be in place to manage quality of service with NHS England or CCGs.

“There have been no issues identified in terms of safety of services.”