Paul McNamara is a GP in Glasgow and honorary clinical lecturer at the University of Glasgow
Rory Woodhouse is a medical student at the University of Glasgow
Medical tourism is on the rise, and I’m starting to see the fallout in my clinic. The surgery happened abroad. The complications happened here. And nobody agreed to that arrangement except, by default, us.
Large numbers of UK residents travelled abroad for medical treatment in 2024.¹ The drivers are straightforward: cost, waiting times, and a social media landscape filled with curated results and before-and-after content that is considerably better at showcasing outcomes than disclosing what happens when things go wrong.² The economics are hard to argue with. The part that gets left out is what comes next.
The funded, planned, well-resourced part of care happens elsewhere. The complications, the uncertainty, the chronic follow-up land back in general practice. Without warning.
Medical tourism doesn’t reduce NHS workload. It splits it. The funded, planned, well-resourced part of care happens elsewhere. The complications, the uncertainty, the chronic follow-up land back in general practice. Without warning. Without resource. And without anyone having agreed to it.
Wound infections, dehiscence, and seromas are not rare outliers. They are predictable downstream consequences of elective surgery with no continuity of care and no postoperative support. No operation note. Limited documentation. No surgeon to call. We are left deciding, with high clinical stakes and minimal information, whether to reassure, investigate, or refer urgently.
The risks do not stop there. Both surgery and long-haul travel independently increase VTE risk; combined, that risk compounds.³˒⁴ Some patients present acutely unwell within days of landing. The surgery may have happened abroad, but the complications are often managed here.
But it is the bariatric surgery patients who expose the deeper structural problem.
Cosmetic complications are acute and visible. Bariatric surgery creates something slower and more insidious. Nutritional deficiencies, iron, B12, folate, vitamin D, calcium, presenting months or even years later with fatigue, dizziness, paraesthesia.⁵ Non-specific symptoms. No clear supplementation plan. Altered gastrointestinal anatomy that complicates the management of diabetes, epilepsy, and mental health conditions.⁶ NICE is clear that lifelong monitoring is required after bariatric surgery.⁷ Many patients returning to the UK have none of it in place.
What begins as an elective procedure abroad gradually becomes a chronic condition managed within the NHS, by a GP who had no involvement in the original decision and no structure to support the ongoing one.
We inherit a long-term condition we had no role in creating. Not because anyone agreed to that arrangement. Simply because there is nowhere else for it to go.
This is not an argument against patient autonomy. People are entitled to seek care wherever they choose, and clinicians have a duty to treat on the basis of need regardless of how that need arose. But the ethical tensions here are currently being resolved in one direction only. Clinical risk and financial cost are absorbed by a system that had no involvement in the original decision. Complications from procedures abroad can place considerable financial strain on NHS services.⁹ UK private providers operating within our own regulatory framework are expected to provide postoperative follow-up and manage complications.¹⁰ Overseas providers operate under different and largely unenforceable regulatory standards once a patient has returned home. Some patients are actively advised by their surgeons abroad to seek ongoing care from their GP.⁸ That is not a pathway. It is an abdication.
The result is an informal aftercare system that has emerged by default. Unfunded. Unsupported. Unregulated. And in some cases unsafe for patients and clinicians alike.
There are things that would help. Clearer primary care guidance on recognising and escalating postoperative complications. Better documentation standards so patients return home with something clinically useful. Honest pre-travel counselling about what NHS follow-up does and does not include. These are basic safeguards, yet much of the current system operates as though postoperative continuity of care is someone else’s problem.
But the deeper question has not been answered, because it has not been asked. Is general practice formally taking on responsibility for the aftercare of procedures arranged privately abroad? If so, where is the resource, the structure, the guidance? And if not, who is?
Right now, the NHS neither claims responsibility nor defines its limits. It just absorbs. And the part of the system doing most of the absorbing, in 10-minute slots, without documentation or support, is us.
We have not reduced pressure on the NHS. We have simply moved it somewhere easier to ignore.
References
- Office for National Statistics (2024/2025). Overseas travel and tourism: international passenger survey data tables. https://backup.ons.gov.uk/wp-content/uploads/sites/3/2025/08/Travel-trends-2024.pdf
- Border P. (2020). Outward medical tourism (POSTbrief 38). Parliamentary Office of Science and Technology. DOI: https://doi.org/10.58248/PB38
- Hatch J. Cosmetic tourism: the cost of going under the knife abroad. Wounds UK. 2025;21(4):44–49. https://wounds-uk.com/journal-articles/cosmetic-tourism-the-cost-of-going-under-the-knife-abroad-for-cosmetic-surgery/
- Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017 Nov 15;8(11):464-474.). DOI: 10.4239/wjd.v8.i11.464
- Alalwan AA, Friedman J, Alfayez O, Hartzema A. Drug absorption in bariatric surgery patients: A narrative review. Health Sci Rep. 2022 Apr 26;5(3):e605.. DOI: 10.1002/hsr2.605
- NICE (2025). Monitoring after discharge from the bariatric surgery service. QS212. https://www.nice.org.uk/guidance/qs212/chapter/Quality-statement-8-Monitoring-after-discharge-from-the-bariatric-surgery-service
- BAAPS. Cosmetic Tourism: What You Need To Know. https://baaps.org.uk/patients/safety_in_surgery/cosmetic_tourism.aspx [accessed 24/6/26]
- Roberts JL, Eckersley M, Davies KJ, Gilmour A. The cost of cosmetic surgery tourism complications to the NHS: A retrospective analysis. Surgeon. 2024 Oct;22(5):281-285. DOI: 10.1016/j.surge.2024.04.012
- IHPN (2022). Medical Governance Framework for independent providers. https://www.ihpn.org.uk/wp-content/uploads/2022/09/IHPN-MPAF-refresh-final.pdf
Featured photo by Alexandre Debiève on Unsplash
