Tier 3 Obesity Management Service

York Teaching Hospital NHS Foundation Trust is delivering a pilot Tier 3 Obesity Management Service. The service is available to patients aged 18 years of age and over, who are registered with a Vale of York CCG GP practice, have a BMI of 35 or over, AND who have maximised primary care and community conservative management including:

Receiving healthy weight and lifestyle advice in primary care
Evidence of active participation in modification to exercise and diet, which is patient- or GP-led, or delivered by an independent commercial service or Tier 2 service, depending on local availability
Trial of pharmacological interventions, where there are no contra-indications
Understanding of the commitment required for the Tier 3 programme and willingness to engage

Patients with a BMI ≥50 will be automatically eligible to access the service, patients with a BMI <50 will need to meet a scoring threshold. The scoring system prioritises patients based on their BMI, as well as their co-morbidities and how recently these were diagnosed. Referrers are encouraged to refer all patients who meet the above criteria and who are willing and able to commit to the programme; those patients who are not prioritised to access the full programme currently will be signposted by the service to suitable alternative support and resources, and will continue to be monitored.

Information about the service

Making a referral

Referrals should be made using the integrated referral forms below, and sent via ICG. The referral form is automatically populated from the clinical system with the patient’s details, history, and co-morbidities; fields requiring manual completion have been kept to an absolute minimum.

An additional benefit of the referral being sent via ICG is that patients can be referred on to Tier 4 (Bariatric Surgery) services, where appropriate, using the same referral and without further administration from the referring GP practice.

Referral form templates for upload to clinical systems:

Guides on how to open RSS templates using the different systems can be found here

FAQs

What is the Tier 3 Obesity Management Service?

The Tier 3 service is a three year pilot of a medically-led multi-disciplinary obesity management programme which has been commissioned by the CCG and is provided by York Teaching Hospitals Trust.

What does the programme involve?

The programme lasts up to 24 months, with an initial 12 weeks of intensive input, followed by periods of monitoring and ad hoc support. During the initial 12 week period, patients will attend group and one to one sessions with a dietitian, physiotherapist and counsellor which will mean they need to attend appointments at the hospital and Energise gym three days a week. N.B. Patients should be made aware of the significant time commitment involved prior to referral.

Who can be referred to the service?

The service is available to patients aged 18 years of age and over, who are registered with a Vale of York CCG GP practice, have a BMI of 35 or over, AND who have maximised primary care and community conservative management including:

Receiving healthy weight and lifestyle advice in primary care
Evidence of active participation in modification to exercise and diet, which is patient- or GP-led, or delivered by an independent commercial service or Tier 2 service, depending on local availability
Trial of pharmacological interventions, where there are no contra-indications
Understanding of the commitment required for the Tier 3 programme and willingness to engage

Patients with a BMI ≥50 will be automatically eligible to access the service, patients with a BMI <50 will need to meet a scoring threshold.

Prior to referral, the referrer should confirm that the patients is willing and able to engage with all of the elements of the programme, which means they should be able to meet the attendance requirements, be able to participate in physical activity, and able to analyse and challenge behaviours which may be sensitive and challenging to explore.

How does the scoring system work?

The scoring system is detailed as part of the referral form itself, which is available in the section above. The scoring system attributes a score based on the patient’s BMI, their co-morbidities, and how recently these have been diagnosed (and therefore how likely it is that systemic damage can be prevented or reversed).

At the beginning of the pilot, it was acknowledged that there may need to be some flexibility in the threshold for acceptance to the programme depending on the volume and nature of the referrals received; the threshold was provisionally set at a score of 12 but with an agreement that where there were unfilled places on the programme, patients with a score lower than 12 may be admitted as exceptions.

Does the service have capacity to accept referrals?

In order to give the programme a robust evaluation, we are aiming to get a balance of patients from the following groups.

Patients with BMI 35 to 44.9, with additional co-morbidities, such as newly diagnosed Type 2 Diabetes Mellitus or non-diabetic hyperglycaemia
Patients with BMI ≥45 and over with other co-morbidities

While we are still evaluating the service there is a fixed number of 100 places each year and we have to make difficult decisions about which patients are likely to benefit most from the programme but there are still places available.

We have spaces available on the up-coming intakes to the programme for patients in the lower BMI group, with newly diagnosed co-morbidities. We would encourage GPs to discuss the programme with any patients that they see who match this description.

We have received a far greater number of referrals for patients with BMI ≥45. Whilst we are still accepting referrals for patients in this group, it means that we are now filling places for the programme for this group some time in advance of the start date. Patients in this group should be advised by the referrer that there may be a wait if they are accepted onto the programme.

What options are there for my patient if they are not accepted to access the programme at the current time?

If the service is unable to offer a patient a place on the programme because they don’t currently meet the access criteria or scoring threshold, a letter is sent to the patient signposting them to other resources and support which is available locally. For example, this might be a local Tier 2 weight management service if they have not already accessed one, or other community activity groups.

All referrals are kept on file and patients may be invited on to the programme at a later date, for example if there are unfilled spaces on the programme and patients with lower scores are being accepted. Furthermore, once a patient has been referred into the service, the service will continue to monitor them on a 6 monthly basis via their GP (if the patient agrees to this by returning a consent slip to the service); if anything changes in the patient’s presentation which means that their score would increase, then their record with the service will be updated and the patient can be accepted directly onto the programme without the need for a further referral.

Can my patient be referred to the programme if they have active mental health problems?

Patients who have active mental health problems, i.e. are under the care of the community mental health teams or in-patient care, should not be referred to the Obesity Management Programme until their mental health problems have been stabilised.

Can my patient be referred to the programme if they are unable to participate in the exercise element of the programme?

The service understands that some patients will have limitations to their mobility. In order to get the maximum benefit from the programme, patients should be physically able to participate in a personalised and adapted physiotherapist-led exercise programme. For patients with chronic pain and musculoskeletal problems, for example cauda equina, referral to MSK and/or the Pain Management service is advised to optimise the patient’s condition prior to referral to the Obesity Management Service.

Who should I contact if I have questions or concerns?

York Tier 3 Weight Management Programme
Phone: 01904 725652
E-mail: yhs-tr.yt3wmp@nhs.net