The NHS Tiered Care Weight Management Pathway

Managing Obesity

NHS Tiered Care Weight Management Pathway

The NHS Weight Management is divided into 4 distinct tiers as follows:

Tier 1: Local authorities are responsible for commissioning

“Behavioural – Universal interventions (prevention and reinforcement of healthy eating and physical activity messages), which includes public health and national campaigns, providing brief advice.”

Tier 1 is delivered by local and regional public health teams, together with the identification and advice, often carried out in a primary care setting, by healthcare professionals such as GPs, nurses, health visitors, school nurses etc. but together with support from pharmacists, local leisure providers and allied organisations.

Tier 2: Local authorities are responsible for commissioning

“Lifestyle weight management services. Normally time limited”

Tier 2 services are delivered by local community weight management services, that provide community based diet, nutrition, lifestyle and behaviour change advice, normally in a group setting environment. Normally people can only access these services for a limited time period often only 12 weeks. Further recent recommendations have suggested that commercial providers may be an effective choice for commissioners for this level of intervention.

Tier 3: CCGs are responsible for commissioning

“Clinician led multidisciplinary team (MDT) – A MDT clinically led team approach, potentially including physician (including consultant or GP with a specialist interest), specialist nurse, specialist dietitian, psychologist, psychiatrist, and physiotherapist.”

In practice these are the specialist weight management clinics that provide non-surgical intensive medical management with an MDT approach that consists of doctor with a special interest on obesity (physician or GP), specialist nurses, specialist dietitian, psychological support and specialist exercise therapists/physiotherapist.

Tier 4:CCGs are responsible for commissioning Tier 4 from April 2017

“Surgical and non-surgical – Bariatric Surgery, supported by MDT pre and post-op.”

Performed in secondary care with pre-operative assessment and post-operative care and support.

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