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BMA ‘cannot support’ QOF incentives for GPs to refer all obese patients

Weight management

The BMA is opposing new QOF incentives for GPs to refer all obese patients to weight management services because ‘GPs do not generally play a major role’ in the process.

NICE’s draft QOF proposals, released last year, would see GPs rewarded if they refer obese patients – those with a BMI of 27.5 kg/m2 or more, or 30 kg/m2 or more for white patients – within three months.

In addition, a separate QOF indicator would incentivise GPs to refer patients with hypertension or diabetes who are also obese within three months of recording their BMI 27.5 kg/m2 or more – or 30 kg/m2 or more if their ethnicity is white.

The Government is backing new QOF indicators for overweight patients after its obesity strategy last year revealed from 2021 it wants to bring in incentives for doctors so all obese patients are offered help.

But the BMA has said it ‘cannot support’ NICE’s two draft indicators, arguing that GPs are not usually involved unless patients are morbidly obese.

Meanwhile the RCGP highlighted not all patients would want a referral and that the doctor-patient relationship may be harmed if they are repeatedly called and offered one.

In its response to NICE’s consultation on the proposals, the BMA said patients tended to self-refer to weight management services.

It noted there were ‘major’ concerns about the availability of weight management services – but said there is ‘no impediment’ for patients to self-refer if CCGs have commissioned an appropriate level of provision.

The BMA added that tackling obesity required ‘a concerted, multi-system’ approach, including a public health campaign with patient/public education on healthy eating and school nutrition policies, and promotions on healthy eating options concerning supermarkets/cafes/restaurants/fast-food chains.

The BMA response to NICE’s consultation said: ‘We cannot support these indicators. Unless a patient is morbidly obese, GPs do not generally play a major role in this process.

‘In most cases a decision to seek weight management services is patient-led and self-referred. Patients have no impediment to self-referral where CCGs have commissioned these services adequately, but at present there are major concerns about the lack of available, appropriate and convenient services.’

The RCGP said in its response to the consultation: ‘Obesity is a cyclical chronic relapsing condition that requires shared decision making and person-centred care. Not all patients want or will consent to a referral and this must be taken into account.

‘Building a relationship with patients may be detrimentally harmed by repeatedly calling patients in for review of their weight and sending a referral that patient does not want.’

It also noted the ‘lack of consistent and available’ weight management services across the country. It said more services would need to be commissioned for GPs to refer into.

The BMA and NHS England are in ongoing discussions about which QOF indicators may be added to the payment framework for 2021.

A Public Health England review last summer called for targeted interventions to tackle obesity in a bid to reduce Covid-19 deaths.

Its review of evidence concluded excess weight leads to a significantly higher risk of hospitalisation and death from Covid-19.


Honest from Yorkshire 21 January, 2021 11:45 am

And so the medicalisation of patients lifestyle choices continues. I used to joke about GPs becoming ‘the botty wiping police’ and having to inspect all patient after each bowel opening to check for adequate cleanliness to prevent pruritus ani. Maybe it is coming.

David jenkins 21 January, 2021 1:38 pm

simples !

patient attends for ear wax, noted to be overweight. explain to them “my contract says i have to refer you to (insert name), i don’t really want to, and you don’t have to accept it; but i still have to do it”

send off pro forma letter to non existent service, copy into notes to prove you’re an excellent doctor, tick a box and “kerching” – order more wine with all the extra money you’ve made !

what a complete waste of everyone’s time ! who the f*ck thought this up ?

Andrew Jackson 21 January, 2021 1:50 pm

I agree
if included (which will be ridiculous but will happen as everything public health related which requires hard decisions is passed to GPs as an excuse)
we will probably get round this by bulk texting an invite to self refer for weight management which will probably be a waste of time but at least relatively simple.

Christopher Heggs 21 January, 2021 8:10 pm

So, my BMI is over 30- it always has been including when I was competing as an athlete many years ago. I am settled with being well muscled and under tall for my weight. I do not want referral to suit the agenda of some less well nourished managers who should have far better things to do with their time in this pandemic than producing such utter garbage with no Cambridge Calgary style input into what the patient wants. I look forward to the culprits going down to the rugby club when we come out of lockdown to tell the scrum they are fat and they need similar compulsion. This is a group that may take even more offence than I do about this hairbrained scheme.
Just remember the degree of authoritarianism about weight is inversely related to the weight of the Doctor. Remember the Not the Nine o clock news sketch about FLAB- fat louts against bikinis?

terry sullivan 21 January, 2021 8:55 pm

ttfo–both to phe and bma

go private or locum or fully employed by nhs?

John Graham Munro 22 January, 2021 12:22 pm