This guidance has been published and should be read alongside the Commissioning Policy A05 Complex and Specialised Obesity Surgery Services of the NHS Commissioning Board April 2013. It has been sponsored by the British Obesity and Metabolic Surgery Society, and is supported by a number of relevant professional bodies, including the Association of UK Dietitians and the Royal College of Physicians. It has also received accreditation from the National Institute for Health and Care Excellence.

Tiers

There are 4 levels of care intervention for people suffering from weight management issues:

1. Tier 1: Prevention and national health promotion
2. Tier 2: Diagnosis
3. Tier 3: Multidisciplinary, specialist services
4. Tier 4: Surgery

This guidance focuses specifically on Tier 3, the specialist assessment of the individual with care delivered by a multi-disciplinary team. It provides evidence, guidance, and recommendations covering the different aspects of quality care management of overweight and obese patients. This document has been written for commissioners, health care providers (including general practitioners, dietitians, and surgeons), patients, and carers, therefore looking at preventive, pre, and post-operative care. The recommendations are very specific, and also take into account best value in addition to best care.

Section 2 introduces the Procedures Explorer Tool, which can be used “to see how individual providers are performing” against quality indicators. Building on this, section 3 describes how the quality dashboards provide an overview of the care activities commissioned by clinical commissioning groups, and suggest the metrics that should be used to measure the quality of care commissioned and delivered. Again, section 4 takes this another step forward, and lists the different measures and standards for care of the obese and overweight, that are applied in primary and secondary care, for example, referral rates, the National Obesity Standard Evaluation Framework, and the National Bariatric Surgery Registry. As part of this, the guidance lists the measures for CQUIN (Commissioning for Quality and Innovation).

Section 5 is referred to as the Directory. It lists all the relevant, best quality patient information and sources of information for clinicians, about weight assessment and management clinics.

Benefits and risks

The guide describes the benefits and risks involved in its implementation, under the following categories:

• Patient outcome and safety
• Patient experience
• Equity of access
• Resource impact

These shows that the guide considers all stakeholders, the patient, the population as a whole, the commissioner, and the health professionals delivering the care.

To support this document, an updated literature review was carried out in July 2013 and is summarised in section 7, where the researchers found that there were a number of gaps in the research about “physical and psychological health rather than weight loss,” and the outcomes from Weight Assessment and Management services. The document does however provide a list of more than 50 references supporting the guidance that has been provided here.

Commentary

Obesity presents such a burden to the population, individuals, and care services. It is a condition which often leads to additional conditions, such as diabetes, stroke, heart disease, etc. This guidance is for everyone involved with care service delivery, from the front-line to the policy decision-makers to the commissioners commissioning the services. The recommendations are clearly set out and so we should all read them, see which apply to our teams, and identify which other teams we need to work with so that patients receive a seamless service and so that we can tackle the growing issue of obesity in England.

Link

Commissioning guide: weight assessment and management clinics (Tier 3) (PDF)
Royal College of Surgeons: England, British Obesity and Metabolic Surgery Society
March 2014

Related material

Clinical Commissioning Policy: Complex and Specialised Obesity Surgery (PDF)
Reference: NHSCB/A05/P/a
NHS Commissioning Board
April 2013