Whilst, in general, I have been very positive about my treatment at the hands of the NHS, I have, at times, had to bring to the readers attention a number of minor problems that I have encountered. A lot, if not all, of the decisions that the NHS take regarding what medication, medical procedures and treatments they should follow and provide are based on risk based and cost benefit analysis statistics. Whilst on its own this sounds sensible, rigidly following guidelines and policies can have unintended consequences. Take for instant your weight. We have all been told for years that we are in the middle of an obesity epidemic and one of the simplest things that can be done to significantly improve the health of the general population is to encourage weight loss. With the recent improvement in available treatments, such as mounjaro, you would think the NHS would be falling over itself to prescribe these types of drugs. Not so.
What may come as a shock to some of my readers is that I am considered to be slightly podgy. You are classified as being clinical obese if your BMI is over 30. I roll in at around 39-40. Approximately 30% of the population are clinically obese. Now, for the past 18 months my liver consultant has been trying to get me on weight loss injections and has referred me to my GP for support. Admittedly it wasn’t until the 3rd request and about 10 months after the first request that I was contacted by my GP, but they did. They then explained that due to NHS guidelines, GPs can’t prescribe weight loss drugs. To centralise and make the system more efficient (and undoubtedly to aid the patient in their weight loss journey by providing a seamless service), there are dedicated weight loss teams and I have to be referred to them by the GP. OK, I thought, now we are making progress. However that is not quite how things panned out.
My GP explained that in order to successfully access weight loss treatment, which is acknowledged to have significant benefits, as well as to meet the request of my liver consultant in his attempts to keep me alive and protect my new liver, you have to pass a devious and diabolical test that is designed to weed out all those not deserving of such treatment. There are roughly 6 criteria of which you must achieve at least 3 but normally 4, before moving on to possible treatment and the promised land. The criteria in no particular order are: level of obesity (BMI over 40), type 2 diabetes, high blood pressure, dyslipidaemia (high cholesterol/abnormal blood fats), established cardiovascular (heart) disease and obstructive sleep apnoea. Does this sound slightly restrictive? For a treatment that could possibly help a sizable minority of the population? Anyway, I’m not here to be critical..
So my GP started to fill out the form. My BMI is almost over 40 (to be honest, three trips to the local Chinese all you can eat for £10 buffet would do it). I have a diabetes diagnosis (even though I’m not diabetic). High blood pressure, high cholesterol or heart disease? No. Sleep apnoea? Maybe. Just to tick this box my GP also referred me to the sleep apnoea team hoping that this would be enough. She was also hopeful that as my liver consultant considered it very important, this would help swing any marginal decision. Within 5 working days the slick machine that the NHS has become swung into action and I received a call from the crack weight loss unit.
‘Is that Mr Bond’, asked the voice over the phone. ‘Yes’ I replied. After confirming my full name, date of birth and postal address (am I likely to forget these facts?), the lady continued. ‘We’ve received your referral from your GP but i’m afraid you don’t meet the necessary criteria and we can’t accept you onto our weight loss program’. Was it due to waiting for confirmation of sleep apnoea I mused? No, we hadn’t got past the first criterion. I had fallen at the very first. I wasn’t fat enough. My BMI of 39 meant they couldn’t consider me for the program. I pointed out that at around 143kg (22 and a half stone) I’m not exactly anorexic and that my liver consultant thought it would help me live longer. But no, thankfully a rigid, no nonsense approach to implementing official guidelines had saved me from myself and the terrifying thought of losing weight. When I asked if she could suggest an an alternative pathway to Satan and weight loss she said I should ask my consultant to prescribe it. Not to be put off, I thanked my saviour and hung up.
About 6 weeks later I was sitting in front of my liver consultant (actually a stand in doctor as, it transpires that, my liver surgeon has gone on a year’s sabbatical without even asking me if I was OK with this! ). When I informed my stand in consultant of the situation she informed me that she was unable to prescribe my weight loss treatment, even though she is a doctor, because the Hospital’s policy is that GPs have to deal with this sort of thing. Again I found myself speechless and so said nothing, just nodding sagely. She did finish by saying that the hospital did have its own weight loss team and she would see is she could refer me to it.
Fast forward 5 weeks and I’m back sitting with my best friend consultant Mr Haq. Having been unable to dodge his right hook (ad passim) he explained that he considered it vitally important that I lost weight and was exceptionally keen that I went onto a weight loss regime using mounjaro or the like. Round and circles came to mind and I outlined previous attempts by the liver team to achieve this almost impossible goal. Nevertheless this did not stop him including in his report on our meeting, a request to my GP to put me onto mounjaro. When I suggested that this would go nowhere he agreed to speak with my liver consultant across the road ( literally). What will be the outcome? I have no idea. I do know though that about 5 hours after my appointment I received a phone call from the clinical nurse specialist asking if I would be happy to consider wearing a specially tailored and fitted abdominal binder (corset). Feeling battered and bruised I gave in and accepted their kind offer.