Last year NHS England, announced a new enhanced service (ES) on weight management that will now continue to run until 31 March 2023.
Practices that signed up for it last year may have found they didn’t make as much progress as they would have liked given all the additional pressures they faced and their reduced capacity to make referrals opportunistically.
The extension is therefore good news for practices keen to maximise income from this service. However, there are some key changes to note, including that the overall funding pot this work has been cut from £20m to £11.5m.
The start date is April1, 2022 and practices had to have to signed up by 30 April.
The ES specification states that practices are to refer patients who are on the practice Obesity Register and ‘ready to make behavioural changes’ to appropriate weight management programmes. To attract payment, the practice must have had a conversation with the patient about weight and obtain their permission for referral – these are important additions compared with last year’s guidance.
The specification defines obesity as a BMI of ≥ 30, or of ≥ 27.5 for those of Black, Asian and other minority ethnic groups.
Practices will be entitled to £11.50 per referral but the number of referrals are capped, as they were last year. So, each practice will be set a ‘referral allocation’ or maximum number of patients they can refer and be notified of that target by their ICS/CCG, once signed up.
We already know this figure will be a minimum of 20% of the number of patients on the practice’s Obesity Register as at 31 March 2020. This reference date has been used because of the likelihood that 2022 Obesity Registers will be artificially smaller, as practices were unable to record patient BMIs during the pandemic. That may be true but there remain a few issues with basing allocations on a register that is two years old. For example, some patients on the 2020 register may since have lost weight and no longer meet the criteria while others may have gained weight but be excluded from the register, as will newly registered patients that are obese. Maximising referrals will also be more tricky for practices that simply haven’t ever kept an accurate register and chosen not to regularly record BMI and code it into the clinical system.
The list of appropriate services patients can be referred to has been revised and now includes more specific criteria for patients that should be referred to an NHS Diabetes Prevention Programme and criteria for referring to an NHS Low Calorie Diet where this service exists.
Practices must make a manual claim (via CQRS) for payment. Claims must be made for the number of unique patients with a qualifying referral (coded on the basis of the SNOMED code below).
The referral to weight management service SNOMED code is 1326201000000101.
The referral to a Diabetes Prevention Programme for those with non-diabetic hyperglycaemia SNOMED code is 1025321000000109.
The referral to a Low Calorie Diet SNOMED code is 1239571000000105.
Any other codes used will not generate payment for these referrals.
By signing up, GP practices commit to restoring the practice Obesity Register to the level of recording at either 31 March 2020 or 31 March 2021, whichever is higher (insofar as that is possible and /or clinically indicated).
1. Taking advantage of all the free resources available for referring to NHS Digital Weight Management Services is vital. It will help embed this activity at practice team level, ensure all your staff are on board with maximising referrals and help streamline processes. Use this link to access the NHS Digital page where you can obtain a folder of resources that is suitable for each different clinical system i.e. EMIS, SystmOne and so forth.
You will need to include you practice code and email address to allow you to download a zipped file that includes the following:
– Weight management searches to identify patients that maybe eligible for a referral. Do note that this search only identifies patients that may be eligible for a referral and does not count how many patients have been referred into the service to date. If the practice intends to use this search, it’s advisable to rename it as appropriate, to avoid confusion with other searches available
– A weight management referral Document template
– Weight management protocol
– Programme instructions, leaflets, and a support poster.
Once downloaded and saved on your local network, you can import the elements you need or want to use from this folder into your clinical system.
2. Make it a team effort by training staff so they all know what the scheme is about, how it works, what the eligibility criteria are and how to have a conversation with patients about it.
3. Set up a pop-up protocol in your clinical system to notify the team when a patient is eligible for a referral. This will encourage anyone in contact with that person to ask if they would like to be referred. Our practice doesn’t use the phrase ‘weight management’ because we feel it’s too personal and instead refer to it as a free wellbeing service. If the patient agrees, we then send a text message (if they have a mobile phone) via AccuRx to confirm this and flag it up as a task for our social prescribers and health and wellbeing coaches to refer into the NHS Digital Weight Management programme.
4. Collaborate with peers, your PCN colleagues and ICS/CCG primary care leads. There are always ways to do things at scale ,which may help you if you are struggling with resources.
5. Utilise locally commissioned weight management services if they fit the criteria – your ICS/CCG should be able to give you a list of organisations. Not everyone can/will want to be referred into the NHS digital programme.
6. Make sure you promote the service in newsletters, on social media, your website and on posters displayed outside the practice. You can also inform local gyms and community centres of the work you are doing, since they may be able to send people your way.
Ryan Smith is a non-clinical partner and strategic manager at Kenilworth and Warwick PCN
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