Joint report on commissioning obesity services published

A  report recommending greater clarity around how obesity care in England is commissioned in the future has been published – Report of the working group into: Joined up clinical pathways for obesity.

It aims to support more equitable access to obesity and weight management services, including obesity surgery, across the country.

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 working group’s report is now published on the NHS England website.

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.

The working group concluded:

  • Local Authorities should retain primary commissioning responsibility for tiers 1 and 2, including population level interventions to encourage healthy eating and physical activity, as well as lifestyle related weight management  services
  • Clinical Commissioning Groups (CCGs) should have primary commissioning responsibility for tier 3, clinician-led specialist multidisciplinary teams
  • NHS England should retain primary commissioning responsibility for tier 4 services, including bariatric surgery, but should consider the transfer of all but the most complex adult bariatric surgery to local commissioning 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.

Professor Jonathan Valabhji, NHS England’s National Clinical Director for Obesity and Diabetes who also chaired the working group, said:

“It is clearly not acceptable that access to obesity services across the country is so variable.  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.

“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.”

Professor Kevin Fenton, Public Health England National Director for Health and Wellbeing, said:

“I welcome the working group report which makes a valuable step to clarifying the commissioning responsibilities, particularly for tier 3 services. 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 working group has now concluded and NHS England and Public Health England are inviting comments from national and local stakeholder organisations, principally concerning implementation at a local level and implications for delivery.

NHS England and Public Health England will publish a summary of any comments received and reference the organisations responding. The information provided may also be used to develop further guidance in accordance with the needs of health and Local Authority colleagues.

To submit comments please email:

One comment

  1. Chris Rose says:

    Out of interest how many tier 3 obesity service providers are there across the UK? The variability in these services is mentioned, I was wondering how this was measured?