UK experts publish guide for commissioning Tier 3 services

Healthcare experts in the UK have published a clinical commissioning guide on weight loss services to assist Clinical Commissioning Groups (CCGs) in commissioning these services and reduce variation in access to weight-loss clinics across the country.

The guidance was developed following a National Institute for Health and Care Excellence (NICE) accredited process and has been welcomed healthcare professionals across several disciplines. It has the backing of five Royal Colleges, the British Obesity and Metabolic Surgery Society (BOMSS), the Faculty of Public Health, the National Obesity Forum (NOF), the British Dietetic Association (BDA) and the British Psychological Society.

Mr Richard Welbourn

“The Royal College of Surgeons and BOMMS have developed a commissioning guide for Tier 3 services which covers weight assessment and management which takes into account the views of ten sponsoring organisations,” said Mr Richard Welbourn, Consultant Surgeon and President BOMSS and Professor John Wass, academic vice-president at the Royal College of Physicians (RCP). “The guide includes input from patients, pathologists, bariatric physicians, general practitioners, public health experts, dieticians, psychologists and healthcare commissioners. It deals with the roles of the weight management clinic, the multidisciplinary team, the role of general practitioners, the role of the clinic itself, referral to bariatric surgery and peri- and post-operative care.”

Although Tier 3 obesity services offer support from clinicians, specialist dietician, psychologist and exercise specialists and are a prerequisite for patients seeking Tier 4 services such as bariatric surgery, surgeons, physicians and other health professionals have been concerned that access to Tier 3 weight management clinics is restricted in some parts of the country.

A lack of provision of Tier 3 obesity services in some parts of the country was highlighted by the Royal College of Surgeons in January 2014 pointing out that it risked leaving obese patients unable to access vital services they need to help control their weight.

Recently, Public Health England and NHS England published a report, which sought to clarify responsibility for providing Tier 3 obesity services and recommended that they should be commissioned by CCGs.

This new guide sets out how those services should be commissioned.                   

Recently published Hospital Episodes Statistics data shows there has been a fall of 10% in the number of bariatric surgical procedures being performed between April 2012 and March 2013, even though the most recently available statistics show obesity rates in England continuing to rise.

“We hope that this guidance will clarify the role of Tier 3 services in helping patients with weight problems,” they added. “We are aware that Tier 3 services need to be developed in a number of areas in the UK. We believe that the service model set out in this guide should be adopted as quickly as possible across the country to ensure that a consistent service is provided to those who need it.”

BOMSS is the sponsoring organisation and the guidance is supported by the Royal College of Surgeons, Royal College of Physicians, the Royal College of General Practitioners, the Royal College of Pathologists, the Royal College of Psychiatrists, The British Dietetic Association, the National Obesity Forum, The Psychological Society and the Faculty of Public Health.

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