Health Optimisation Prior to Routine Surgery Pathway Urgent or non-routine? Y Start of Process Lifestyle advice (including offering referral to wt management or smoking cessation whilst awaiting outpatient appointment if appropriate) If diagnostic uncertainty, Advise patient that if planned surgery is the outcome they will still need to complete the 6 month health optimisation period unless exclusions apply N Possible Referral to surgical speciality Y Other Exclusions? (see yellow box) N Y BMI >=30 or smoker? N Y Diagnostic Uncertainty N Refer Include non smoker and/or BMI <30 in referral on RSS template 6 month health optimisation period GP to discuss with patient: Option to refer to weight management programme and/or stop smoking service leaflet Set Individualised goals, including other lifestyle factors eg alcohol consumption N Is this considered as an exceptional case for IFR panel? Refer Include smoker and/or BMI >=30 – exclusions apply on RSS template Y N Approved by IFR panel? Y Y Seen in outpatients. Conversion to planned surgery (daycase or inpatient)? N stops smoking > 4 weeks (ideally confirmed by certificate from smoking cessation service) and BMI now <30 NB – USE CLINICAL DISCRETION AT ANY TIME GP Refer Include smoker and/or BMI >=30 – health optimisation period complete in referral on RSS template Y Y Urgent or non-routine? N GP assesses whether reminder needs setting up Y N Discharge /follow up as planned 6 months completed Y Other exclusions ? (see yellow box) List of exclusions: Any urgent or non-routine procedures Patients undergoing surgery for cancer 2WW Referral for suspicion of cancer Patients with a BMI of 30 or greater but who have waist measurement less than 94cm in males or 80cm in females Patients with severe mental health illness, Learning Disability or significant cognitive impairment Referrals for interventions of a diagnostic nature e.g. endoscopy Children under 18 years Frail Elderly (as a guide – 3 or more of the following: unintentional weight loss; self-reported exhaustion; weakness (grip strength); slow walking speed; low physical activity) NB Does not currently apply to ophthalmology or dentistry/oral surgery N Refer back to GP with written advice to patient and GP that patient will need re-referring when health optimisation period complete N Is this considered an exceptional case for IFR panel? Proceed to surgery Y N Y Approved by IFR panel? Health Optimisation Prior to Routine Surgery Pathway