Enhanced service specification - NHS England

Classification: Official Publications approval reference: PAR699

Enhanced service specification

Weight management 2021/22

Version 1, 21 June 2021

Contents

1. Introduction .......................................................................... 2 2. Commonly Used Terms ........................................................ 2 3. Background.......................................................................... 3 4. Process ................................................................................ 4 5. General Requirements ......................................................... 5 6. Service Delivery Specification............................................... 6 7. Payment and Validation........................................................ 9 Annex A: Provisions relating to GP practices that terminate or withdraw from this ES (subject to the provisions below for termination attributable to a GP practice formation or merger) and New GP practices ...................................................................... 11

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1. Introduction

1.1. This ES is subject to amendments from time to time. It is a national specification that cannot be varied locally

1.2. This ES is offered by the Commissioner to all General Medical Services, Personal Medical Services and Alternative Provider Medical Services contract holders.

1.3. An ES is designed to cover and/or support enhanced aspects of clinical care, all of which are beyond the scope of essential and additional services. No part of this ES specification by commission, omission or implication defines or redefines essential or additional services.

1.4. All GP practices are offered the opportunity to sign up to this ES provided they meet the requirements of this specification. By signing up to deliver this ES, a GP practice agrees to a variation of its primary medical services contract to incorporate the provisions of this ES. The provisions of this ES are therefore deemed a part of the GP practice's primary medical services contract.

2. Commonly Used Terms

2.1. This specification is referred to as this "ES".

2.2. In this ES:

2.2.1. the "Commissioner" refers to the organisation with responsibility for contract managing these ES arrangements, which is NHS England

2.2.2. a "GP practice" refers to a provider of essential primary medical services to a registered list of Patients under a General Medical Services contract, Personal Medical Services agreement or Alternative Provider Medical Services contract who has agreed with the Commissioner to deliver this ES

2.2.3. a GP practice's "Obesity Register" is its register of patients aged 18 years or over with a BMI 30 in the preceding 12 months which the GP

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practice establishes and maintains under the Quality and Outcomes Framework1

2.2.4. "Weight management services" are the services listed in paragraph 6.11; and

2.2.5. "Referral allocation" is the capped number of referrals to weight management services allocated to each GP practice that attract a referral payment under this ES.

2.3. In this ES words importing the singular include the plural and vice versa.

3. Background

3.1. In 2018/19 the majority of adults in England (63%) were overweight or obese with 26% of men and 29% of women considered obese or morbidly obese (NHS Digital, 2020).2 The COVID-19 pandemic has highlighted the importance of weight management. Living with excess weight puts people at greater risk of serious illness or death from COVID-19, with risk growing substantially as body mass index (BMI) increases. 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.

3.2. As noted in the 2020 government policy document Tackling obesity: empowering adults and children to live healthier lives,3 GP practices are often the first port of call when patients need health advice and support (GOV.UK, 2020).4 The government has stressed the need to increase the frequency of interventions for obesity in general practice care with a focus on improving referral pathways into weight management services in every local health care system. The aim from 2021 is to ensure that everyone living with obesity is offered support for weight loss.

1 For the avoidance of doubt, although 2021/22 QOF indicator OB002 means a GP practice obesity register will contain patients with a BMI 30, referrals under this ES should also include patients from Black, Asian and other minority ethnic groups with a BMI 27.5. 2 3 4

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3.3. To support this ambition an additional ?70m will be invested in Local Authority and NHS funded weight management services in 2021. This is in addition to the earlier commitments outlined in the NHS Long Term Plan to make weight management services available from 2021 to those living with obesity with diabetes and/or hypertension, and the doubling of the NHS Diabetes Prevention Programme over the next five years, including a new digital option to widen patient choice and target inequality.

3.4. There is good evidence to suggest that general practice plays a pivotal role in the identification of people living with obesity, discussion of the associated health issues and facilitating access to weight management services. There is also evidence to suggest that clinicians proactively offering weight management support is acceptable to patients living with obesity.5

4. Process

4.1. This ES begins on 1 July 2021 and shall continue until 31 March 2022 unless it is terminated in accordance with paragraph 4.2.

4.2. This ES may be terminated on any of the following events:

4.2.1. the Commissioner is entitled to require that the GP practice withdraws from this ES as set out in this ES;

4.2.2. the Commissioner is entitled to terminate this ES where the GP practice has failed to comply with any reasonable request for information from the Commissioner relating to the provision of the services pursuant to this ES; or

4.2.3. the GP practice terminates this ES.

4.3. The Commissioner must invite all GP practices to participate in this ES by 8 July 2021. GP practices must sign up to participate in this ES on or before 31 July 2021 unless the Commissioner agrees otherwise. GP practices must record their agreement to participate in this ES in writing to the Commissioner.

4.4. Payment under this ES is conditional on GP practices:

5 The Lancet:

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