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.