GPs to receive ‘allocation’ for referring obese patients via new weight management ES

GP practices will be given an ‘allocation’ of patients that they can refer to the new weight management enhanced service, NHS England has said.

This is to ‘maximise referrals while ensuring expenditure stays within the £20m funding envelope’, the specification said.

But it comes despite the spec also stating that the ‘aim from 2021is to ensure that everyone living with obesity is offered support for weight loss’.

And it quoted NHS Digital 2018/19 figures which estimated this as 26% of men and 29% of females in England.

Participating practices will be paid £11.50 per referral, up to the limit of their referral allocation.

Practices will be notified of their initial allocation based on the practice Obesity Register as at 31 March 2020 – at a minimum one third of the number of patients on the register.

This will be revised once it is clear how many practices have signed up, with practices informed of updated allocations by 31 August. 

The ES comes as the Covid pandemic highlighted the importance of weight management, NHS England said, with nearly 8% of critically ill patients classified as morbidly obese (compared with 2.9% of the general population.

However, it said ‘there is evidence that the numbers of people identified by general practice as living with obesity have fallen during the pandemic’.

In a scathing statement issued last week, the BMA branded the ES as micromanagement which fails to put trust in GP and will make little difference to the country’s obesity crisis. GP Committee chair Dr Richard Vautrey also said there was ‘no use having such a scheme in general practice when receiving specialist services are so patchy across the country, with many having long waiting times or being already full’.

Participating practices will be expected to:

• develop and implement a protocol* for the identification and support of patients living with obesity; and
• restore the practice Obesity Register to, at a minimum, the level of recording at 31 March 2020 (insofar as that is possible and / or clinically indicated).

The ES defines obesity as a BMI ≥ 30 or ≥ 27.5 for those of Black, Asian and other minority ethnic groups.

Patients identified as being ‘ready’ to engage with weight management services should be referred to:

• NHS Digital Weight Management services for those with hypertension and/or diabetes.
• Local Authority funding tier 2 weight management services
• Diabetes Prevention Programme for those with non-diabetic hyperglycaemia; or 
• Tier 3 and Tier 4 services 

*Practice protocols for identifying obese patients should:

• normalise conversations about weight and weight management in all consultations, not just those for long-term condition management;
• recognise that these conversations need to be handled sensitively, using shared decision-making principles, to understand if a patient would want to be referred;
• consider how all opportunities for the identification of people living with obesity are maximised, including how this can be achieved during telephone, virtual and face to face consultations. encourage patients to provide the practice with information on their weight, BMI and other self-reportable health information;
• record an updated BMI annually, where a patient has had a BMI recorded in their record that indicates they are living with obesity;
• record and maintain details of available weight management services and how to refer to them.

Source: NHS England