The commissioning of weight loss services is currently being reviewed and the current provision causes a number of issues.
Bariatric Surgery is a Tier 4 weight management service. There is little access to bariatric care on the NHS and therefore some patients go privately.
GP's should be aware that follow-up following any bariatric surgery should be provided by the specialist for at least 2 years post surgery.
If a patient has private bariatric surgery and does not purchase all of their follow-up care privately then they will need to be referred into the NHS (this is further complicated if they would not have met the criteria to have the surgery on the NHS).
An IFR (Individual Funding request) should be made for follow-up care following private surgery
Norfolk and Waveney ICB position currently is that patients who receive care privately have to have their follow-up privately and they do not accept any applications under IFR.
Patients should raise their concerns with the ICB.
Please see.
Locally referrals to Tier 3 weight management services are paused because of a lack of capacity within the funding envelope.
However, patients can access Tier 3 weight management services through Right to Choose with Oviva
Many practices will have received direct email from Oviva advertising referral under Right to Choose rules. The ICB has acknowledged that this route is available for patients not already on Oviva’s Tier 3 Weight Management waiting list.
The preference of the ICB is that GPs should not use this route as it is more costly and may be deemed as unfair on those already waiting, along with the ICB not being able to contractually quality assure this particular service.
Despite the ICB’s preference the LMC feel this is a service that is available and should be offered to our patients where clinically appropriate.
Referral Information for Oviva
Oviva Tier 3 Weight Management - Oviva Website
ICB GP Bulletin containing confirmation of Oviva as RTC provider
Tirzepatide (Mounjaro) for managing overweight and obesity
Following the ICB Medicines Optimisation Programme Board (MOPB) the classification of this drug for the indication of weight management has been amended from Red-Hospital Only to
- BLUE - NWICB are committed to fund positive NICE TA treatments. Awaiting clarification of place in pathway and commissioning arrangements. For all other treatments, formulary application and discussion will be required.
Our understanding is this is because the ICB have an obligation to fully review the implementation of the NICE guidance and they cannot classify the drug as Red until this is done.
We would like to highlight however, that in practical terms there is no change.
GP’s should not be prescribing tirzepatide for patients for the indication of weight management.
They should refer these patients to Tier 3 services where available.
The LMC are liaising with the ICB on the development of the weight management services. The prescribing of tirzepatide requires the commissioning of wrap around services for intensive diet and exercise advise and psychological support which is not core general practice. The services need to be commissioned before any consideration can take place for prescribing in general practice. Therefore, practices should not consider prescribing.
Please see our further guidance on requests from private providers
There is currently an NHSE National Enhanced Service for Weight Management
The aims of this ES are:
6.1.1. to support practices to develop and implement a proactive approach to the identification of patients living with obesity;
6.1.2. to work with wider system partners on developing pathways which incorporate multi-modal access options including online, telephone and face to-face and to empower patients to actively provide and update their practice with this information online, and
6.1.3. to support practices to engage with individual patients living with obesity and, following a conversation with the patient, to refer patients who are ready to make behavioural changes to appropriate weight management programmes.
Acceptable referrals will include:
- NHS Digital Weight Management services for those with hypertension and/or diabetes. This should be the default option for this cohort of patients; Individuals who satisfy all the following eligibility criteria may be referred to this service:
- aged 18 or over
- diagnosis of diabetes (type 1 or type 2) or hypertension or both
- a BMI of 30kg/m² or higher in people from White ethnic groups adjusted to 27.5kg/m² or higher in people from Black, Asian and other ethnic minority groups.
- Local Authority funded Tier 2 weight management services
- NHS Diabetes Prevention Programme for those individuals with non-diabetic hyperglycaemia aged 18 years or over, up to and including eighty years old. Individuals who are over eighty years old are eligible to access the Service if their GP provides written confirmation to the Provider that the GP perceives the benefits of the NDPP to outweigh any potential risks of participating in a weight loss programme for that individual
- referrals to the NHS Type 2 Diabetes Path to Remission Programme; or
- Tier 3 services (in line with local service inclusion criteria) and Tier 4 services
Funding is £11.50 per referral. Please bear in mind there is a cap to the number of referrals you will be funded for.