Summary guide: new weight management enhanced service

NHS England is putting £20m into a new enhanced service for GP practices to manage and refer patients for weight management interventions. Here Pulse Intelligence provides an overview of the requirements and payment arrangements for the new service.

The new service was announced on 17 June and promised £20m funding for weight management referrals.

Details announced in the service specification revealed that payment would be effectively capped so that practices refer only a proportion of the patients on their obesity register. This is provisionally set at a third of registered patients at each practice, though this may rise depending on how many practices sign up and share the total £20m funding available.

It is worth noting that the BMA GP Committee has already voiced concerns about the service specification and funding, arguing it is a ‘laborious tick-box exercise’ and that the ‘very limited’ funding does not match up to the work involved.

As things stand, however, the service is set go ahead and practices have until the end of next month to sign up.

Here are some of the key points that practices need to know about the service requirements and payment details.

Background

The enhanced service follows a 2020 government document Tackling obesity: empowering adults and children to live healthier lives, which referred to GP practices as the ‘first port of call’ when patients need health advice and support, and noted government plans to increase interventions for obesity in general practice and improve referral pathways to weight management services.

To make sure everyone living with obesity is offered support for weight loss, NHS England is putting £70m into Local Authority and NHS funded weight management services in 2021. This is ‘in an addition to’ earlier NHS Long Term Plan commitments to make weight management services available from 2021 to all those with obesity and/or hypertension, and ‘doubling’ of the NHS Diabetes Prevention Programme.

The service specification document notes that in 2018/19, 26% of men and 29% of women were considered obese or morbidly obese. It also highlights how excess weight puts people at greater risk of serious illness or death from COVID-19, and that nearly 8% of critically ill patients with COVID-19 in intensive care units have been morbidly obese, compared with 2.9% of the general population who are morbidly obese.     

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

Key dates

The service officially starts on 1 July 2021 and ends on 31 March 2022 (unless terminated earlier).

Practices should receive an invite to participate by 8 July 2021 and must sign up on or before 31 July 2021 (unless their commissioner agrees otherwise).

Aims

There are two stated aims, namely that practices should:

• develop and implement a proactive approach to identity patients with obesity (defined as a BMI ≥ 30, or ≥ 27.5 for those of Black, Asian and other minority ethnic groups) both within the practice ‘and with wider system partners’.
• engage with individual patients living with obesity and refer those ready to make behavioural changes to appropriate weight management programmes.

Components

There are two components to the service:

1. Developing a supportive environment

This requires practices to:

• Make sure their staff involved in delivering the service are trained in conversations about lifestyle and weight management, and are given protected learning time;
• Develop and implement a protocol to identify and support patients living with obesity;
• Review and maintain the GP register. This will mean restoring the practice’s register to what it was on 31 March 2020, as a minimum (insofar as this is possible/clinically indicated).

2. Patient support and referral

This requires practices to:

• For patients on the QOF Obesity Register as of 31 March 2021 or identified during the service, assess and record each patient’s readiness to engage with weight management services. This should include a recent BMI measurement (within 12 months) and an offer of a referral to an appropriate service.
• Ensure all referrals are made by suitably trained and competent healthcare professionals
• Obtain informed patient consent to engage with and be referred to weight management services, including sharing of relevant patient data.

The spec stresses that assessment and referral can be done opportunistically rather than at standalone consultations.

Services that can be referred to are:

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

Payment mechanism

Practices will be paid £11.50 per referral per patient, but only up to the limit of their ‘referral allocation’ – a certain number of the patients on their register they can refer. This is to ensure the spend doesn’t exceed the £20m funding available.

Initially the referral allocation will be a minimum of one-third of the number of patients on the practice QOF Obesity Register at 31 March 2020.

This may be revised depending on how many practices sign up for the ES – practices will be informed of their revised allocation by 31 August 2021.

Also the referral allocations will be kept under review and commissioners will be able to increase or reduce allocations from 1 January 2022, if it’s found a practice has achieved less than 40% of its total referrals by 30 November 2021 – so as to reallocate unused funding amongst practices and maximise referrals.

The ES specification notes though that commissioners may waive the referral mechanism altogether and pay for any excess referrals out of their local commissioning funds.

How payment will be claimed

Payment claims will be made manually and will be for the number of unique patients with

1. a qualifying referral (SNOMED code: 1326201000000101)

AND

• a BMI recorded since 31 March 2020 of ≥ 30, or of ≥ 27.5 for patients from Black, Asian and other minority ethnic groups.

Claims will need to be made on a monthly basis, within 12 days of the end of the month when the referral was made. Payments will be made monthly via manual payment.

Source: NHS England. Enhanced service specification: Weight management 2021/22 Published 21 June 2021