Comprehensive review of Tier 3 & Tier 4 Weight Management Services

November 10, 2022 • Reading time 2 minutes


The NHS Long Term Plan Implementation plan committed to provide enhanced Tier 3 services for people living with more severe obesity and comorbidities. The existing provision of Tier 3 and Tier 4 services varied materially between different places and the level of this variation was not well understood.

To support improved service provision and close this information gap, Edge Health were commissioned by the GIRFT Projects Directorate @RNOH to develop a survey for all CCGs, Tier 3 providers and Tier 4 providers in the country and analyse the results. The objective of this work was to build a robust “state of play” of current service provision, as well as better understand variation between systems and the impact of Covid-19 on the delivery of weight management services.

Approach and research

Three surveys were developed: for CCGs, Tier 3 providers and Tier 4 providers. In total 232 responses were received, covering more than 90% of all CCGs and providers. The survey covered a range of topic areas, including:

  • Level of access to services
  • Location of services
  • Referral volumes
  • Activity volumes and the impact of Covid-19
  • Size and shape of the waitlist
  • Workforce
  • Eligibility criteria and interventions

In addition, each ICS was asked to submit a high-level recovery and expansion plan detailing estimates of the level and nature of investment needed to improve services within their system.

Key findings

The survey results highlighted the substantial impact of the Covid-19 pandemic on weight management services and the impact this had on waiting times for treatment. At the time of the survey, the share of 18+ and 52+ week waits for Tier 3 and Tier 4 treatment were materially higher than seen in other specialties.

The work also highlighted substantial variation in access to services and activity volumes, with some regions seeing materially higher population-adjusted referral volumes or likelihood of having to travel to a different system for treatment.

Output and next steps

In addition to a national report, reports were produced for every region with detailed analysis of each provider and benchmarking with other regions. These reports contained recommendations for key lines of enquiry and next steps for implementing best practice in weight management services.


Edge Health are a specialist UK healthcare analytics consultancy that use data and insights to improve the delivery of health and care services, so that better outcomes can be delivered more efficiently.