BOMSS standards for clinical services

BOMSS Standards for Clinical Services and

Commissioning Guidelines
PROVIDING BARIATRIC SURGERY
BOMSS Standards for Clinical Services & Guidance on
Commissioning
for and on behalf of BOMSS Council, October 2012
BOMSS Service Standards and Commissioning Advisory
Working Party:
Alberic Fiennes

Chandra Cheruvu

Sally

Shaw Somers

Pratik Sufi

Mike

Peter Small

Shamsi El Hasani

Brian

Mary OKane

Keith Seymour

Ian Be

INTRODUCTION
Established Severe Obesity is disease state, for which bariatric surgery is the
only current clinically effective and cost-effective treatment.
BOMSS recognises existing national and international guidelines as the outline
principles of good practice. The present Standards are intended to support
translation of these principles into practical service and quality structures for
the UK.
Good practice evolves, so the present standards remain work-in-progress and
represent a consensus gathered at the time of writing. The full text available
for download below should be consulted.

IN SUMMARY
Senior professionals in each bariatric team must satisfy themselves and their
Clinical Governance Lead that their practice and service meet the existing
published standards.
Bariatric care should be safe, kind, based on recognised best practice,
effective and cost-effective.
Patients should be treated in an appropriate facility by the appropriate
clinicians.
BOMSS recognises the concept of Metabolic Surgery, but deprecates the
promotion, marketing and provision of bariatric procedures with primarily
cosmetic intent and/or at inappropriately low BMI.

The exact application of guidance may differ between NHS units, commercial
providers in the independent sector and private provision by free-standing
clinician groups, but BOMSS recommends that the following be upheld in all
bariatric service provision.

CORE REQUIREMENTS FOR A BARIATRIC SERVICE

1. PURPOSE OF A BARIATRIC SERVICE
Any safe and reasonable bariatric care pathway service should comprise:

assessment of patient suitability and of treatment needs.

structured and documented information giving,
patient preparation, personal and clinical.
technically competent surgical treatment, transparently and appropriately chosen.
post-operative support for patients in making adjustments to their lives after
surgery.
safe and continued clinical follow-up: provision of surgery without that
commitment is deplored.

2. GENERAL SERVICE STRUCTURE:

Service delivery should be through a multidisciplinary and multi-professional
team (MDT process).
The core MDT should at least comprise:

Specialist Bariatric Surgeon(s)

Bariatric Nurse Specialist(s)
Specialist Bariatric Dietitian(s)
There should be standing and immediate access to specialist physicians,
psychologist or psychiatrist and senior anaesthetists , all with experience of
bariatric patients needs. Standing referral pathways are also needed to wider
support disciplines
The MDT should be led by a bariatric surgeon. It may have links to a medical
obesity service, but BOMSS does not recommend a structure that reduces the
surgical team to technician status.

Assessment

A bariatric service should be able to undertake a reproducible, comprehensive

multidisciplinary needs- and risk assessment, including:

stringent physiological scrutiny of super-obese and super-super-obese patients

screening for Eating Disorders and psychological morbidity.
consideration of the most suitable procedure, including its potential risk profile.

Support and Counselling

A bariatric service must offer education, guidance and motivational support

throughout treatment .

3. PERSONNEL
Professional personnel working with the team must meet BOMSS Professional
Standards. All personnel at provider institutions must recognise the
sensitivities of bariatric surgery patients.

4. FACILITIES

Facilities at which bariatric surgery is undertaken must meet BOMSS

Professional Standards, in part re-iterated in the present full text. The
development of networks may support facility needs.

Equipment

Bariatric surgery should only be undertaken in facilities that are adequately

equipped.

Theatres

Operating theatres must able to support safe surgery, including emergency

re-operating.

Post-operative Recovery

Bariatric patients must have access to appropriate levels of recovery and

critical care support.

5. PROCESS
Patients should receive bariatric care on a standardised pathway, under
protocols addressing

referral guidelines and the management of funding ,

self-referral issues and primary care liaison
inappropriately rapid process
working roles and competencies of team members
governance, risk management and risk responsibility to ensure that patients are
operated on within the competence of the surgeon and team

6. INFORMATION & CONSENT

Along the treatment pathway patients must be given information that enables
them to give genuine consent to the treatment pathway and to the surgery.

7. FOLLOW-UP
Two important components must be provided for in the follow-up care of
bariatric surgery patients:

The care of post-operative complications and delayed emergencies.

Continuous clinical follow up to support clinical outcome, micronutrition and
patient needs
Lack of any surgical or surgeon-led consultations over the ensuing period is
deplorable.
BOMSS advises professionals participating in such processes to consider
whether they are placing themselves in professional jeopardy.
BOMSS advises strongly against the commissioning of services within the NHS
that omit or seek to limit the period of follow-up in Secondary Care.

8. AUDIT
BOMSS is committed to national audit through the National Bariatric Surgery
Registry.

9. KEY QUALITY INDICATORS

The present guidelines consider which outcome indicators are appropriate and
which may be less so. The focus should be on comorbidity resolution,
rehabilitation and well-being, not just weight loss.

10. SERVICE INTEGRITY

Achieving the preceding standards implies that a Service must have critical
mass, so that new services may be best developed within a network.
Independent sector providers and private practice clinician groups will need
their own mechanisms for emulating these minima.

SERVICE VIABILITY
In many instances high quality service is currently provided by very
experienced individuals and teams with lower volumes and personnel
establishment tha