Tier 2:

• The GP practice of a patient identified as having morbid obesity should identify a health professional who will act as the advisor to each patient and who will assist in drawing up a specific programme of non-surgical measures.

• Regular assessment should be undertaken to review progress.
  Programmes available are:

• Non-surgical resources available to control obesity include: counselling; psychological assessment and programme; medication; exercise programmes; dietician input.

• Patients and GPs can access additional Tier 2 services through LiveWell Dorset.

Tier 3:

• The GP practice will support the patient in a co-ordinated way (Tier 2) for at least two years prior to considering referral to the Tier 3 Weight Management Programme (WMP). No further details on Tier 3 were available.

Tier 4:

Services available are:

• On completion, the Tier 3 WMP will provide recommendations for each individual regarding future weight management including appropriateness of referral for bariatric surgical assessment.

• NHS England currently commission Tier 4 bariatric surgery services and require that all individuals have attended and complied with a local Tier 3 WMP before referral to Tier 4 bariatric surgery services can be considered.