HP449 Obesity management checker

Overview/Purpose

This protocol supports QOF 2026/27 achievement for the new obesity indicators OB004 and OB005.

It is triggered when a BMI is entered and checks whether the patient meets the relevant BMI threshold for obesity management activity. Where action may be required, the protocol alerts the user and offers appropriate coding options.

What does it do?

When a BMI is entered, the protocol assesses whether the BMI meets the threshold for action under OB004 or OB005.

If the BMI does not meet the relevant threshold, the protocol ends without alerting the user.

If the BMI meets the threshold for OB004, the protocol alerts the user that the patient may need referral to a weight management service, or that a reason for not referring should be recorded.

The options offered include:

• referral to weight management service
• weight management service unavailable
• unsuitable for weight management programme
• referral declined
• exit

If the BMI meets the threshold for OB005, the protocol checks whether the patient appears to meet eligibility criteria for obesity pharmacotherapy and behavioural support.

Where the patient meets the criteria, the protocol prompts the user to record the appropriate activity or a reason why this cannot be completed.

OB005 eligibility support

For OB005, the protocol checks whether the patient has the required comorbidities that support eligibility for weight management pharmacotherapy, including tirzepatide.

Where the patient has 4 out of 5 relevant conditions, the user is alerted that the patient meets criteria and is prompted to complete the relevant actions.

Where the patient has 3 out of 5 conditions, the protocol reviews the record to identify whether the patient may be close to eligibility but has missing or incomplete coding.

Examples include:

• raised blood pressure but no hypertension diagnosis recorded
• raised HbA1c but no diabetes diagnosis recorded
• QRISK above 10% but no statin/lipid-lowering therapy recorded
• previously abnormal lipids but no current-year bloods recorded

This helps the clinician decide whether further review, coding or investigation is appropriate.

Why is it important?

OB004 and OB005 introduce new QOF activity around obesity management. This protocol helps users respond at the point a BMI is entered, rather than relying on retrospective searches alone.

It supports practices by:

• identifying patients who may need referral to weight management services
• supporting appropriate recording where referral is declined, unavailable or unsuitable
• identifying patients who may be eligible for obesity pharmacotherapy
• highlighting missing information that may affect eligibility
• improving coding quality for obesity-related QOF indicators
  

What will the user see?

Where the patient meets the OB004 threshold, the user will see an alert explaining that the BMI is eligible for a weight management referral and asking them to select the appropriate outcome.

Where the patient meets OB005 criteria, the user will see an alert explaining that the patient meets criteria for obesity pharmacotherapy and behavioural support.

Where the patient may be close to OB005 eligibility, the protocol may display information to support review of potentially missing diagnoses, coding or investigations.

Recommended user action

Users should:

• review the alert shown
• consider whether referral to weight management is appropriate
• record referral, decline, unsuitability or service unavailability where relevant
• review possible missing diagnoses or investigations where the patient appears close to OB005 eligibility
• record shared decision-making and pharmacotherapy activity where clinically appropriate
  

System Dependencies

This protocol depends on accurate recording of:

• BMI
• ethnicity
• hypertension
• type 2 diabetes
• HbA1c
• blood pressure
• lipid results
• QRISK
• lipid-lowering medication
• obstructive sleep apnoea
• ASCVD
• bariatric surgery
• weight management referrals
• pharmacotherapy/shared decision-making activity
  

System Triggers

System trigger: BMI entered
Run mode: Always run
Enable trigger for: Clinical users entering BMI

Change management considerations

Practices should ensure users understand:

• when OB004 and OB005 apply
• how BMI thresholds differ by ethnicity
• which conditions contribute to OB005 eligibility
• how to record weight management referral outcomes
• how to record reasons why referral or pharmacotherapy cannot be completed
• that the alert supports clinical review but does not replace clinical judgement
  

How to get it

This protocol is installed as part of the PCIT Handy Protocols set.