Bariatric surgery: how to refer

Please use the tabs below for information on how to refer patients to our service, including our specific referral criteria.

Referrals can only be accepted if they are submitted via the electronic Referrals System (eRS).

If you are a Derby city or Derbyshire GP, please refer to the Tier 3 Weight Management Service > provided by Derbyshire Community Health Services.

The British Obesity and Specialist Surgery Society > provides guidance for the management of patients undergoing bariatric surgery. This includes access to a GP Hub.

Pre-surgery referral criteria

We accept referrals from Nottinghamshire and Lincolnshire patients who have completed a specialist weight management program that meets the appropriate Tier 3 services standards.

The following criteria for referral to East Midlands Bariatric and Metabolic Surgery Institute (EMBMI) include:

Note: Patients who smoke or drink excess alcohol (more than 14 units per week) at entry into Tier 3 programmes need to show evidence of stopping smoking (complete smoking cessation) and reduction of alcohol consumption to less than 14 units per week at the end of their Tier 3 programme to be accepted for referral for bariatric surgery.


Criteria 1

BMI > 40 (or appropriate ethnic adjustment — see note 1 below)
AND
b) Type 2 diabetes with
AND
c) either one of the following
  • Inadequate Control (HBA1c >64mmol/mol) on maximal oral therapy
  • Presence of nephropathy (eGFR <45 OR Albumin:Creatinine ratio >10mg/mmol)
  • Metabolic dysfunction associated Steatohepatitis (MASH - aka as NASH)
  • Onset of diabetes under the age of 40yrs old
  • Insulin resistance (>2units/kg/day)
 

Criteria 2

a) Patient with BMI >35 kg/m2 (or appropriate ethnic adjustment — see note 1 below)
AND
b) Requiring time-sensitive surgery/procedure:

e.g. Organ transplant, arthroplasty because of immobility, spinal surgery, cardiac surgery, cancer surgery, limb or sight saving surgery, abdominal wall hernia repair, fertility treatment

(N.B. this list is not restrictive and subject to discretion of MDT team)

Please specify and supply supporting documentation.


Criteria 3

a) BMI >40 kg/m2 (or appropriate ethnic adjustment — see note 1 below)
AND
b) at least  two of the following significant comorbidities:

  • BMI >50 kg/m2
  • Sleep apnoea requiring CPAP
  • Systolic or diastolic cardiac dysfunction (i.e. Heart failure)
  • Resistant hypertension (3 or more blood pressure tablets)
  • Idiopathic intracranial hypertension
  • Metabolic dysfunction associated Steatohepatitis (MASH - aka as NASH)
  • Atrial fibrillation
     

Criteria 4

Any rare or monogenic condition where bariatric surgery or drug intervention has been shown to provide significant clinical benefit. NB. these will be assessed on an individual basis.

Please specify and provide supporting documentation.

Post-operative referral criteria

We accept referrals for patients with a history of bariatric surgery if they are experiencing symptoms that may be related to their surgery which requires investigation/treatment.

We also accept referrals for patients with a history of bariatric surgery who are pregnant.

We do not accept referrals for post-operative weight regain, or for routine post-operative care after private bariatric surgery performed in the UK or abroad.

Please refer patients with a history of bariatric surgery via the NHS Referral Assessment Service (RAS):

Post Operative Bariatric Surgery RAS > find under GI and Liver (Medicine and Surgery) >Upper GI inc. Dyspepsia.

Referrals for problematic gastric band assessments should be submitted from GP practices via the same referral pathway as described above.


Common concerns with gastric bands and when to seek referral

Patients should be referred for assessment if they experience any of the following:

  • Increasing reflux, regurgitation, or vomiting

  • A sudden loss of restriction

  • Pain around the port site

  • Difficulty tolerating foods of certain textures


These symptoms may indicate that the band’s restriction level needs 
reviewing. A band adjustment may be recommended to help relieve symptoms and restore appropriate function.

If the gastric band was originally inserted privately, we are able to offer a one-off assessment to support diagnosis of symptoms and provide a band deflation if clinically required. However, we are unable to assume ongoing routine care and cannot perform band inflations to increase restriction. Any further routine band management must be arranged through a private provider.