NEL Weight Management Services Update for 2026/27
NHS England are making a series of refinements to the Quality Outcomes Framework (QOF) for 2026/27 to strengthen alignment with updated NICE guidance and support more clinically effective care. The Obesity Enhanced Service will be retired, in favour of two new obesity related indicators to support referrals into structured weight management programmes and delivering weight loss injections as shown in the table below. The exact QOF indicators will be released in due course.
To fund the new obesity‑related QOF indicators NHS England have utilised the national ICB allocations for obesity management. In NEL during 2025/26, this funding was previously used to support tirzepatide prescribing on behalf of primary care through the Barts Health Specialist Weight Management Service. As NHS England transitions to a QOF‑funded, primary‑care‑led model from 2026/27, this funding is being realigned. This planned change explains why current specialist hospital services are being affected and supports a consistent, sustainable approach via primary care going forward.
- Please note that NEL ICB will be updating this information every two to three weeks to ensure GPs are updated with the most recent local and national information.
- The final NHS England QOF guidance is awaited.
- Clear pathways and decision support tools will follow once national requirements are confirmed.
News 25 March 2026
- Patients already on treatment at Barts Health SWMS
| All patients who have already started treatment will continue under specialist care. These patients will not be discharged back to primary care as a result of the current changes. |
- Patients already accepted onto the pathway
| Referrals accepted before 1 April 2026 will continue to be seen, even if appointments take place after 1 April. This is for cohort I (2025/26): ≥4 qualifying comorbidities and BMI ≥40 (12‑month cohort) |
- Do not make any new referrals for tirzepatide at this time
| SWMS are not accepting any new referrals for tirzepatide weight‑management services. This pause is pending confirmation of final NHS England QOF and commissioning arrangements. |
- The Homerton Specialist Weight Management Service (SWMS) will not be commissioned to provide tirzepatide on behalf of primary care.
- Patients not yet accepted onto the pathway
| Patients not yet started and not within the cohort 1 will be discharged back to primary care. This reflects the anticipated shift to primary‑care‑led prescribing once QOF requirements are finalised. This includes cohort II (2026/27) and cohort III (2026/27–2027/28) – see below for further details. |
- Access to semaglutide is still possible via Right to Choose.
Further useful information
Cohort Access Groups for Implementation in Primary Care
| Funding Year* | Cohort Duration | Cohort | Eligibility (Comorbidities) | BMI Threshold** |
| Year 1 (2025/26) | 12 months | Cohort I | ≥4 qualifying comorbidities: hypertension, dyslipidaemia, obstructive sleep apnoea (OSA), cardiovascular disease, type 2 diabetes | ≥40 |
| Year 2 (2026/27) | 9 months | Cohort II | ≥4 qualifying comorbidities (as above) | 35–39.9 |
| Year 2/3 (2026/27–2027/28) | 15 months | Cohort III | 3 qualifying comorbidities (as above) | ≥40 |
* Funding year refers to the financial year.
** Use a lower BMI threshold (usually −2.5 kg/m²) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African‑Caribbean ethnic backgrounds.
Qualifying Comorbidities – Definitions for Initial Assessment
| Qualifying Comorbidity | Definition |
| Atherosclerotic cardiovascular disease (ASCVD) | Established ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, or heart failure |
| Hypertension | Established diagnosis requiring antihypertensive treatment |
| Dyslipidaemia | On lipid‑lowering therapy or LDL ≥4.1 mmol/L or HDL <1.0 mmol/L (men) / <1.3 mmol/L (women) or fasting triglycerides ≥1.7 mmol/L |
| Obstructive sleep apnoea (OSA) | Confirmed diagnosis via sleep study with treatment indicated (e.g. CPAP) |
| Type 2 diabetes mellitus | Established diagnosis of type 2 diabetes |
Information for sharing with patients
Patients are not being denied treatment. There may be a short delay. Delivery arrangements are changing, with future prescribing expected to be supported through your GP once national arrangements are finalised.