This folder supports achievement of the following QOF indicators for patients with BMI indicative of obesity recorded during the contract year:

• OB004 – Obese BMI and referral to weight management programme 

• OB005 – Higher obese BMI with pharmacotherapy, shared decision making agreed, and referral to support programme

These searches help manage invitations, borderline readings, high-risk patients, PCA opportunities, and antiplatelet status confirmation.

The searches have been built to look at the contract year (1st April to 31st March), so it is recommended to run the search WITHOUT a relative run date.

🧾 ACTION | Latest BMI at least 30 but not recorded this year

Patients whose most recent BMI is at least 30 (or at least 27.5 if BAME), but it has not been recorded during the current contract year. Targeting these patients for an updated BMI reading may make them eligible for OB004, and potentially OB005. 

• Action: Contact or invite patient to obtain an up to date weight, then calculate BMI.

🧾 ACTION | Started tirzepatide in last 12 months but no obesity pathway code

Patients with a BMI of at least 35 recorded this year who started tirzepatide during the last 12 months. It is essential to add code 'NHS obesity medication pathway started' [2386231000000101] dated within the current contract year for patient to be eligible for OB005. These patients are currently excluded from the OB005 denominator after rule 2.

Review patient records to understand when and where tirzepatide was initiated. If recent (ie: within a few months of the start of the contract year) think about whether adding code is justified.

🧾 NOT ACHIEVED | Target now for obesity pharmacotherapy (OB005)

Patients with a BMI of at least 35 (or 32.5 for BAME) recorded during the contract year, as well as 4 qualifying conditions who do NOT have a recorded shared decision-making discussion about the management of obesity and have NOT been offered NICE approved medicines management (pharmacotherapy) for use in a primary care setting with accompanying referral to suitable behavioural support programme. 

Use the report to understand which conditions have caused the patient to be included. Some understanding of the qualifying criteria may be necessary, especially for ‘dyslipidaemia’.  

Consider separating patients into those who are already taking medication for obesity (ie: they only need referral to a behavioural support programme), and those not on medication who first need to be offered therapy. 

🧾 ACTION | Target for obesity pharmacotherapy after updated BMI

Similar to above in the sense that patients have the 4 qualifying criteria, but the most recent BMI was recorded before the start of the contract year. Simply recording a BMI will cause a patient to move to the NOT ACHIEVED search above, but consider working through these patients simultaneously.

These reports are configured to display the latest values. This means that it is possible for patients in the NOT ACHIEVED | Target now... report to appear whose latest BMI is less than 35 (or 32.5 if BAME background). Such patients have had a BMI above threshold during the year - making them eligible for OB005 - but have subsequently lost weight. They remain eligible for the remainder of the year, and may be an "easy win" to help achieve OB005.

🧾 NOT ACHIEVED | Target now for referral to weight management (OB004)

Patients with a BMI greater than or equal to 30 recorded in the contract year (or a BMI greater than or equal to 27.5 for patients with a BAME background), who have NOT been referred to a weight management programme within 90 days of the BMI being recorded. 

To maximise patient opportunities, patients coded with at least 2 invitations for obesity are included. Use the report to identify recent BMIs. The user who coded the BMI is included to assist in identifying patterns were individuals may have forgotten to offer a referral. 

🧾 REVIEW | 3 long term conditions with raised BP

Patient has 3 conditions of ASCVD, type 2 diabetes, obstructive sleep apnoea, dyslipidaemia, and most recent blood pressure is suggestive of hypertension. 

Use the report to review latest values then target patients. Repeating BMI and BP followed by a new diagnosis of hypertension may add patient to OBES2_REG. 

🧾 REVIEW | 3 long term conditions with raised HbA1c

Patient has 3 conditions of ASCVD, hypertension, obstructive sleep apnoea, dyslipidaemia, and most recent HbA1c is suggestive of type 2 diabetes.  

Use the report to review latest values then target patients. Repeating BMI and HbA1c followed by a diagnosis of type 2 diabetes may add patient to OBES2_REG. 

🧾 REVIEW | 3 long term conditions without dyslipidaemia this year

Patient has 3 conditions of ASCVD, hypertension, type 2 diabetes, obstructive sleep apnoea, but most recent blood results suggestive of dyslipidaemia not during the contract year.  

Use the report to review latest values, and any lapsed courses of lipid lowering therapy. Repeating BMI and bloods may add patient to OBES2_REG. 

Issuing 1 course of lipid therapy in the second half of the contract year may be sufficient to make the patient eligible for OB005. 

The three 3 long term conditions searches are based on patients whose latest BMI is at least 34. There is a perverse notion here that patients with a BMI just under 35 actually need to gain weight in order to have access to NHS weight loss programmes. Where the latest BMI was recorded before the contract year and was just below 35, a new weight reading may mean the BMI now exceeds the 35kg/m2 threshold.