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Obesity services

Report: transfer surgery to commissioning groups

Local Authorities should remain as the commissioners of tiers 1 and 2 of the obesity care pathway

A report from NHS England and Public Health England that investigated the variability in the commissioning of, and patient access to, ‘tier 3’ services, has concluded that NHS England should consider the transfer of all but the most complex adult bariatric surgery (tier 4) to local commissioning groups.

The transfer should take place “once the predicted increase in volume of tier 4 activity has been realised and once locally commissioned tier 3 services are shown to be functioning well”.

Although the report states that Clinical Commissioning Groups (CCGs) are the preferred option as the primary commissioners for local weight management, Local Authorities should remain as the commissioners of tiers 1 and 2 of the obesity care pathway.

NHS England and Public Health England convened a short-life working group, made up of a broad membership including representation from local commissioners and national health and social care bodies, to look into ways in which the pathway and co-ordination of the clinically led elements of care might be improved in the future.

The group explored concerns about variations in local commissioning of certain obesity services across England and in particular, concerns about access to clinician-led specialist multidisciplinary teams, commonly referred to as tier 3 services.

“It is clearly not acceptable that access to obesity services across the country is so variable,” said Professor Jonathan Valabhji, NHS England’s National Clinical Director for Obesity and Diabetes who also chaired the working group. “This report is an important first step in providing much needed clarity about the future commissioning arrangements for all obesity care services and ensuring greater equity of access to obesity care wherever patients live in England.

The report noted that in some areas, no organisations were commissioning multi-disciplinary team interventions, leaving some patients unable to access bariatric surgery.

“I welcome the working group report which makes a valuable step to clarifying the commissioning responsibilities, particularly for tier 3 services,” said Professor Kevin Fenton, Public Health England National Director for Health and Wellbeing. “We should also recognise that there remains much for us all to consider for improving and integrating the system, at all tiers, going forward. This includes the need to continue building effective partnerships across health and local government.”

The new report has outlined the preferred approach to commissioning responsibilities across the different tiers to ensure uniform provision across the country.

“We are now keen to hear from as many stakeholders as possible, both locally and nationally, who have views about progressing implementation of this report at a local level,” said Valabhji.

Both the PHE and NHS England are inviting comments from national and local stakeholder organisations, principally concerning implementation at a local level and implications for delivery. Comments should be sent to by 6th May 2014.

The working group’s report is available on the NHS England website, please click here to access the report.

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