Primary Care Metabolic Surgery

The Primary Care Metabolic Surgery (PCMS) Service aims to identify appropriate patients suitable for weight loss management which could lead to metabolic surgery. Focusing on patients who are diabetic with uncontrolled hyperglycaemia and severely obese, patients are supported through Tier 2, Tier 3 and Tier 4 as appropriate.

Tier 1

Behavioural – Universal interventions (prevention and reinforcement of healthy eating and physical activity messages), which includes public health and national campaigns, providing brief advice. Tier 1 is delivered by local and regional public health teams, together with the identification and advice, often carried out in a primary care setting, by healthcare professionals such as GPs, nurses, health visitors, school nurses etc. but together with support from pharmacists, local leisure providers and allied organisations.

Tier 2

Lifestyle weight management services. Normally time limited. Tier 2 services are delivered by local community weight management services, that provide community based diet, nutrition, lifestyle and behaviour change advice, normally in a group setting environment. Normally people can only access these services for a limited time period often only 12 weeks. Further recent recommendations have suggested that commercial providers may be an effective choice for commissioners for this level of intervention.

Tier 3

Clinician led multidisciplinary team (MDT) – A MDT clinically led team approach, potentially including physician (including consultant or GP with a specialist interest), specialist nurse, specialist dietitian, psychologist, psychiatrist, and physiotherapist. In practice these are the specialist weight management clinics that provide non-surgical intensive medical management with an MDT approach that consists of doctor with a special interest on obesity (physician or GP), specialist nurses, specialist dietitian, psychological support and specialist exercise therapists/physiotherapist.

Tier 4

Surgical and non-surgical – Bariatric Surgery, supported by MDT pre and post-op. Performed in secondary care with pre-operative assessment and post-operative care and support.