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Surgical programme

Establishing a bariatric service

Mr Andrew Gilliam, consultant bariatric surgeon
Communication and a multidisciplinary team the key to success

Establishing effective channels of communication and gathering together a multidisciplinary team of bariatric specialists is the key to developing a successful surgical bariatric service, according to Mr Andrew Gilliam, consultant bariatric surgeon, Darlington Memorial Hospital, UK.

Speaking at the inaugural Durham & Darlington Obesity & Bariatric Symposium to celebrate the first 12 months of the surgical bariatric programme, he outlined the key considerations and practicalities of “Setting up a bariatric surgery service”.

The County Durham and Darlington NHS Foundation Trust launched its surgical bariatric service in October 2011 and the first gastric bypass procedure was performed by the bariatric team in November 2011.

“There are many key factors one must consider when looking to establish a bariatric service,” began Gilliam. “The most important aspect is ensuring the safety of the patient at all times, from pre-surgical checks to regular post-surgical follow-up sessions.”

He also underlined the importance of appointing a multi-disciplinary team of specialists with the programme to assess and care for the patients at every stage of treatment. Such specialists include, but are not limited to; specialist nurses, a dietician, diabetologist, pharmacist, respiratory physician, anaesthetist, psychologist, theatre and ward staff, and surgeons.

There are currently three surgeons in the bariatric programme: Mr Gilliam, specialist bariatric consultant Mr Akeil Samier and upper GI consultant surgeon Mr Andrew Mitchell.

Fundamental to the success of the programme is providing patients with access to the service. “Therefore, it is paramount that key personnel “buy into” what you are trying to achieve and provide you with the resources that will be required,” he said.

This includes GPs, who in order to refer their patients must believe that the bariatric programme is offering their patients an effective treatment. The board of the NHS Trust must also be persuaded that the programme is providing a valuable and cost effective service for patients

“Finally, you must convince your colleagues that the programme is something that can be a part of and deliver to be of benefit of patients,” said Gilliam.

In addition to the personnel, there is a variety of essential specialist equipment required including: scales, specialist chairs and commodes, hoists, bariatric beds and operating tables, trollies and hover mattresses, wheel chairs, a wet room and theatre kit.

In the future, Gilliam said that he hoped the bariatric programme could be expanded to include a Community Weight Management Service and a new commissioning process providing greater access for patients.

He also said that the service will be expanded to incorporate a new dedicated laparoscopic theatre performing revision surgery, as well as concentrating more resources on research and education.

“It is also our desire to be recognised as one of the best centres for providing bariatric surgery, and therefore we will be applying for an IFSO Centre of Excellence certification.”

According to Gilliam, the service has succeeded so far due to the excellent communication between the entire multi-disciplinary team.

“It is vital that all of the team communicates and has an equal voice. Therefore, you must value each member of your team whether they are a surgeon, nurse, ward staff or dietician. Each plays a crucial role in delivering safe and effective outcomes, sharing their specialist knowledge with the whole team and, more importantly, the patient.”

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