SRP 113 Access to Tier 3 specialist weight management services

Policy number: SRP 113
Policy name: Access to Tier 3 specialist weight management services
Status: Group Prior Approval
Effective date: 26 November 2024
Next review date: 26 November 2027

NHS Mid and south Essex Integrated Care Board (MSE) commissions Tier 3 specialist weight management services. This service provides dietetic intervention, psychological support, physical activity advice and pharmacological intervention where appropriate. The service is non-consultant led and is provided by Oviva® in Mid Essex and Morelife® in South Essex until 31 March 2025. A single provider will be appointed to deliver the service across mid and south Essex from 1 April 2025.  

Access to Tier 3 specialist weight management services is via GP referral only.  

Eligibility criteria 

The eligibility criteria is based on the Kings Obesity Staging criteria (stages 2 and 3) to ensure those with greatest clinical need are able to access the service. 

Patients must meet all of the following criteria: 

  • Adults (aged 18 or over)  
  • Registered with an MSE practice, or if unregistered residing in MSE  
  • BMI ≥40 kg/m2 

AND has at least one of the following conditions:  

  • obstructive sleep apnoea  
  • severe asthma  
  • cor pulmonale,  
  • obesity hypoventilation syndrome,  
  • requires CPAP (continuous positive airway pressure), 
  • ischaemic heart disease, 
  • heart failure,  
  • QRISK score of >20% 
  • a diagnosis of type 2 diabetes mellitus. 
  • sub-fertility  
  • oesophagitis  
  • severe gastro-oesophageal reflux disease  
  • Barrett’s oesophagus.  

In addition: 

  • Willingness to commit to changing behaviours, measured through objective evidence-based assessment tools such as Patient Activation Measures 
  • Evidence to demonstrate Tier 2* interventions have been completed, where Tier 2 was suitable and appropriate for that individual. 

The following people are not eligible for this service:  

  • Aged 17 years or under 
  • Pregnant or breastfeeding 
  • Have an active eating disorder. 
  • Have undergone bariatric surgery in the past 12 months. 
  • Have been diagnosed as pre-diabetic- more appropriate for the NHS diabetes prevention programme 
  • Have been discharged from a Tier 3 weight management programme within the last 2 years at the time of referral.  
  • Those with unstable/uncontrolled 
    • Alcohol or drug use 
    • Hypothyroidism 
    • Cushing’s syndrome 
    • Mental illness  

Access to pharmacological treatment 

In line with NICE guidance, in mid and south Essex access to licensed GLP1 weight loss medications currently Wegovy™ (semaglutide) and Saxenda™ (liraglutide) is only through the Tier 3 specialist weight management service.  These drugs are not available via prescription from a GP, or via other weight management programmes. 

Pharmacological treatment will be considered only after dietary, exercise and behavioural approaches have been started and evaluated. 

Only patients meeting the above criteria will be funded for treatment, as part of the Tier 3 specialist weight management service, with the following weight management medication: 

Liraglutide for managing overweight and obesity 

Technology appraisal guidance [TA664] Published: 09 December 2020 

Semaglutide for managing overweight and obesity 

Technology appraisal guidance [TA875] Published: 08 March 2023 

Tirzepatide for managing overweight and obesity

In line with NICE TA and in line with NHSE interim commissioning policy. 

when: 

  • they meet the criteria as stated in the NICE TA, and for a maximum period of 24 months (except Tirzepatide), and  
  • there is continued engagement with the weight management service, a reduced-calorie diet and increased physical activity and 
  • they lose more than 5% of the initial weight after 6 months of treatment and this weight loss is sustained. 
  • Patients who meet the NICE criteria for discontinuation (not achieving 5% weight loss at 6 months from initiation) will be transferred to the non-medication Tier 3 weight management service pathway. 
  • There is no evidence of effectiveness if semaglutide is used as a single stand-alone treatment. Marketing authorisation for liraglutide and semaglutide specifies use as an adjunct to a reduced-calorie diet and increased physical activity. 

*Tier 2 Services explained: 

For compliance with the current Tier 3 referral policy, people should access Local Authority-commissioned, NHS England-commissioned, or commercially available Tier 2 programmes which meet the following criteria: 

  • Multi-component course, i.e. diet, physical activity and behaviour change.  
  • Focused on life-long lifestyle change. 
  • Course lasts at least 3 months. 
  • Sessions are held weekly or fortnightly.  
  • Each session includes a weigh-in. 
  • Specific dietary targets are set, agreed and monitored. 
  • Discussions around reducing sedentary behaviour and physical activities that can be easily incorporated into everyday life for the long-term. 
  • Use a variety of behaviour-change methods. 

Local authorities are responsible for commissioning Tier 2 support, which, depending on the service, can be accessed via self-referral or via the GP. Example of services offered include: 

NHS England additionally offer Tier 2 services, accessible via GP referral. Programmes offered include: 

For Access to Tier 4 Bariatric Surgery see SRP 114 Specialist Obesity Services 

Individual funding requests should only be made where the patient demonstrates clinical exceptionality.   

Find out more information on applying for funding in exceptional clinical circumstances