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.