Non-clinical partner Ryan Smith offers advice on boosting referrals
NHS England, has announced that the enhanced service (ES) on weight management, introduced a few years ago now, will continue to run until 31 March 2025.
Practices that signed up previously may have found they didn’t make as much progress as they would have liked given all the additional pressures they have been facing and their reduced capacity to make referrals opportunistically.
The extension is therefore good news for practices keen to maximise income from this service. The overall funding pot for this work remains the same as last year at to £7.2m, as does the referral cap.
What are the main points about the scheme?
The start date is 1 April 2024 and to participate, practices have to sign up by 29 April.
The ES specification states that practices are to refer patients who are on the practice Obesity Register and ‘ready to make behavioural changes’ to appropriate weight management programmes. To attract payment, the practice must have had a conversation with the patient about weight and obtain their permission for referral.
The specification defines obesity as a BMI of ≥ 30, or of ≥ 27.5 for those of Black, Asian and other minority ethnic groups.
Practices will be entitled to £11.50 per referral but the number of referrals are capped, as was the arrangement in previous years. So, each practice will be set a ‘referral allocation’ or maximum number of patients they can refer and be notified of that target by their ICB, once signed up.
We already know this figure will be a minimum of 12% of the number of patients on the practice’s Obesity Register as at 31 March 2023.
However, practice-level referral allocations will be kept under review – ICBs/commissioners can either increase these where surgeries are achieving their allocation or reduce them from 1 October 2024, if achievement is less than 40% of their total allocation.
‘This reallocation of funding entitlements between practices will help to maximise practices’ referrals through the scheme’, the guidance says.
The ES sets out the list of appropriate services patients can be referred to (and the specific criteria patients must meet), which have slightly changed this year. They include NHS Digital Weight Management services, the NHS Diabetes Prevention Programme, the NHS Type 2 Diabetes Path to Remission Programme, local authority-funded Tier 2 weight management services and ICB-level specialist Tier 3 and Tier 4 services.
Practices must make a manual claim (via CQRS) for payment. Claims must be made for the number of unique patients with a qualifying referral, coded on the basis of the SNOMED codes below:
- For the weight management service, the SNOMED code is 1326201000000101.
- For the NHS Digital Weight Management programme, the SNOMED code is 1402911000000108.
- For the Diabetes Prevention programme for those with non-diabetic hyperglycaemia, the SNOMED code is 1025321000000109.
- For the Type 2 Diabetes Path to Remission programme, the SNOMED code is 10239571000000105.
- For Tier 3 specialist Weight Management services, the SNOMED code is 1403011000000103.
- For Tier 4 specialist Weight Management services, the SNOMED code is 1402991000000104.
Any other codes used will not generate payment for these referrals.
By signing up, GP practices commit to maintain the practice Obesity Register to, at a minimum, the level of recording at 31 March 2023 (insofar as that is possible and /or clinically indicated).
How can practices maximise referrals and therefore income?
1. Speak to your ICB contracts team now to understand what your practice and/or PCN referral allocation is, this will be your target for the year. ICBs will regularly review these allocations so it is worth speaking to them in Q3 to understand if yours have changed. If they have been increased make sure you adjust your targets to get the maximum income available.
2. Taking advantage of all the free resources available for referring to NHS Digital Weight Management Services is vital. It will help embed this activity at practice team level, ensure all your staff are on board with maximising referrals and help streamline processes. Use this link to access the NHS England page where you can obtain a folder of resources that is suitable for each different clinical system i.e. EMIS, SystmOne and so forth.
You will need to include you practice ODS code and email address to allow you to download a zipped file that includes the following:
– Weight management searches to identify patients that maybe eligible for a referral. Do note that this search only identifies patients that may be eligible for a referral and doesnot count how many patients have been referred into the service to date. If the practice intends to use this search, it’s advisable to rename it as appropriate, to avoid confusion with other searches available
– A weight management referral Document template
– Weight management protocol
– Programme instructions, leaflets, and a support poster.
Once downloaded and saved on your local network, you can import the elements you need or want to use from this folder into your clinical system.
3. Make it a team effort by training staff so they all know what the scheme is about, how it works, what the eligibility criteria are and how to have a conversation with patients about it.
4. Set up a pop-up protocol in your clinical system to notify the team when a patient is eligible for a referral. This will encourage anyone in contact with that person to ask if they would like to be referred. Our practice doesn’t use the phrase ‘weight management’ because we feel it’s too personal and instead refer to it as a free wellbeing service. If the patient agrees, we then send a text message (if they have a mobile phone) via Accurx to confirm this and flag it up as a task for our social prescribers and health and wellbeing coaches to refer into the NHS Digital Weight Management programme.
5. Collaborate with peers, your PCN colleagues and ICB primary care leads. There are always ways to do things at scale, which may help you if you are struggling with resources.
6. Utilise locally commissioned weight management services if they fit the criteria – your ICB should be able to give you a list of organisations. Not everyone can/will want to be referred into the NHS digital programme.
7. Make sure you promote the service in newsletters, on social media, your website and on posters displayed outside the practice. You can also inform local gyms and community centres of the work you are doing, since they may be able to send people your way.
Ryan Smith is a non-clinical partner and strategic manager at Kenilworth and Warwick PCN
