Non-clinical partner Ryan Smith offers advice on boosting referrals
NHS England, has announced that the enhanced service (ES) on weight management, first introduced two years ago, will continue to run until 31 March 2024.
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 faced and their reduced capacity to make referrals opportunistically.
The extension is therefore good news for practices keen to maximise income from this service. However, there are some key changes to note, including that the overall funding pot for this work has been cut again for a second year in a row from £11.5m to £7.2m, and the referral cap has been reduced.
What are the main points about the scheme?
The start date is 1 April 2023 and to participate, practices have to sign up by 28 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 (these changes were introduced last year).
The specification defines obesity as a BMI of ≥ 30 in people of White ethnic groups, 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% (down from 20% last year) of the number of patients on the practice’s Obesity Register as at 31 March 2020.
This reference date has been used because of the likelihood that 2023 Obesity Registers will be artificially smaller, as practices were unable to record patient BMIs during the pandemic. That may be true but there remain a few issues with basing allocations on a register that is three years old. For example, some patients on the 2020 register may since have lost weight and no longer meet the criteria while others may have gained weight but be excluded from the register, as will newly registered patients that are obese. Maximising referrals will also be more tricky for practices that simply haven’t ever kept an accurate register and chosen not to regularly record BMI and code it into the clinical system.
The guidance sets out the list of appropriate services patients can be referred to (and the specific criteria patients must meet), which include NHS Digital Weight Management services, the NHS Diabetes Prevention Programme, the NHS Low Calorie Diet programme where this service exists, 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 is1025321000000109.
- For the Low Calorie Diet, 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 restoring the practice Obesity Register to the level of recording at either 31 March 2020 or 31 March 2021, whichever is higher (insofar as that is possible and /or clinically indicated).
How can practices maximise referrals and therefore income?
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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