National/local context and evidence base

The NHS Commissioning board issued a document on Clinical Commissioning Policy; complex and specialised obesity surgery in April 2013 which also discussed the role of Tier 3 specialised weight management services. It stated that the treatment of obesity should be multi-component. Specialist (Tier 3 or Tier3/4) weight management programmes should include medical assessment of patients, treatments and lifestyle changes such as improved diet, increased physical activity, behavioural interventions, low and very low calorie diets, pharmacological treatments, psychological support and the consideration of referral for bariatric surgery if clinically appropriate. The staff within the team must have specialist Obesity qualifications (e.g. SCOPE certification) and training. Facilities should include the capacity to work from an appropriately equipped site, with specialised medical equipment and the ability to enable access to the appropriate level of physical activity.

Only once patients have successfully completed a minimum of 6 months of intensive obesity management can they be referred for bariatric surgery under NICE guidelines, and a year or longer is recommended. The six months spent in pre-assessment at a surgical centre can count towards the year.

North Norfolk CCG (NNCCG) and South Norfolk CCG (SNCCG) are therefore providing this service specification to specify the delivery required by a Tier 3 Weight Management services for the registered NNCCG and SNCCG population.

Local defined outcomes

Initial Outcomes

— A reduction in patients' weight of ≥1-5% within 6 months of joining the programme in 50 % of attenders,

— A reduction in patients' weight of ≥5% within 12 months of joining the programme in 70 % of attenders,

— A reduction in obesity related drug prescriptions,

— An improvement in quality of life scores,

— An increase in physical activity,

— An increase in healthy eating.

Intermediate Outcomes

— An increase in NNCCG and SNCCG clinical staff knowledge on the treatment of obesity,

— An improvement in Diabetic related morbidity.

Long-term Outcomes

— A reduction in the incidence of obesity related illness – for example Diabetes (Hba1c score),

— An improvement in weight loss maintenance, sustained and continued weight loss,

— Contribute to a reduction in the prevalence of adult obesity in North and South Norfolk,

— A reduction in prescriptions for medication for conditions linked to obesity,

— A reduction in obesity related admissions for Diabetes and Musculoskeletal (MSK).

The detailed outcomes for this service and the approach to evidencing these outcomes will be agreed with the service provider after contract award (See Appendix 1).

Aims and objectives of service

The aim of the Community Specialist Weight Management Service (CSWMS) is to improve the health and well-being of morbidly obese adults by supporting them to achieve and maintain a healthier weight and improve physical fitness, through making appropriate and sustainable lifestyle changes to their eating and physical activity habits.

The provision of a CSWMS is expected to:

— Support patients to make long-term lifestyle changes to manage their weight, improve their health status and their quality of life,

— Manage the access to bariatric surgery,

— Improve the screening process for those patients who are eligible for bariatric surgery.

The key functions of this Tier 3 CSWMS will be:

— To deliver a high quality clinically led programme on behalf of and within the geographical areas of North Norfolk CCG and South Norfolk CCG for referred patients, including the consideration of using a ‘hub and spoke' model,

— The service will provide multi-disciplinary team assessment and intervention to motivated patients who fit the referral criteria and have tried other weight loss services but have not achieved their goals e.g. commercial weight loss programmes, primary care support or Tier 2 weight management services,

— The service will function as part of a seamless care pathway for adult overweight and obesity,

— The service will, where appropriate, refer patients for Tier 4 surgical assessment, and will contribute to the pre-operative management of these patients.

The key deliverables of this Tier 3 Community Specialist Weight Management Service are:

— That each eligible obese adult referred to the service is offered a comprehensive multi-disciplinary assessment in line with NICE guidelines,

— That each individual assessed as suitable for the service is given an individual, tailored treatment plan consisting of effective and appropriate therapeutic and educational interventions,

— Interventions will address patients' presenting needs and enable them to develop coping strategies and make behavior changes to achieve an initial weight loss of 5-10% body weight and sustained weight loss towards longer term goals, in line with clinical guidelines,

— Each adult meeting the NHS Commissioning Board criteria for Tier 4 referral will be assessed for suitability for referral to Tier 4,

— Adults found suitable for Tier 4 will be referred in line with criteria.