NHS England has confirmed the introduction of two new obesity indicators into the 2026/27 QOF framework. Together they represent a significant expansion of QOF into the management of obesity, reflecting both the scale of the public health challenge and the arrival of new pharmacological treatments. These indicators sit within the Public Health domain and carry a combined total of 18 points.
The indicators use the standard NICE definition of obesity. Adults with a BMI of 30 kg/m² or above are included, with a lower threshold of 27.5 kg/m² for people from South Asian, Chinese, other Asian, Middle Eastern, Black African and African‑Caribbean backgrounds. This ethnicity‑adjusted threshold is important, as it will influence the size of the denominator for both indicators. A BMI must have been recorded within the previous 12 months for a patient to be counted.
The first indicator requires practices to refer between 10% and 30% of adults living with obesity to a weight‑management programme. The referral must take place within 90 days of the BMI being recorded. This creates a clear operational requirement: practices will need reliable BMI coding, a way of identifying eligible patients in real time, and a straightforward referral pathway that clinicians and administrative teams can use without delay.
Although the indicator does not prescribe the type of programme, it is expected that referrals will be to locally commissioned Tier 2 weight‑management services. Where these services are limited or oversubscribed, practices may need to work with their ICB to clarify acceptable alternatives.
The second indicator is more substantial and reflects the phased national rollout of new weight‑loss medicines, including tirzepatide. Practices will be required to record a shared decision‑making conversation with 50% to 80% of eligible patients. This discussion must cover management options, including the offer of NICE‑approved pharmacological treatments where appropriate, alongside behavioural support.
Eligibility for medication is tightly defined. The initial national cohort includes people with a BMI over 40 and at least four weight‑related comorbidities, with further cohorts added over time. Some ICBs are applying additional local restrictions, meaning practices will need to be aware of both national and local criteria. The shared decision‑making requirement does not oblige clinicians to prescribe; it requires a documented conversation that explores risks, benefits, alternatives and patient preferences.
Delivering these indicators will require a degree of planning. Practices will need dependable BMI recording processes and a way of ensuring ethnicity‑adjusted thresholds are applied consistently. Templates within EMIS, SystmOne or Vision will be essential to support structured documentation of shared decision‑making conversations. Practices may also need to consider how they identify eligible patients, how they schedule these discussions, and how they ensure referrals are made within the required timeframe.
These indicators represent a notable shift in QOF, moving beyond simple case‑finding into more active management of obesity. They will require additional clinical and administrative time, particularly during the first year of implementation. However, they also provide an opportunity to standardise care, improve access to evidence‑based interventions and support patients at a time when new treatment options are emerging.
NICE has approved tirzepatide (Mounjaro®) for managing overweight and obesity under Technology Appraisal TA1026, and NHS England has published interim commissioning guidance outlining how it will be introduced nationally. However, in Doncaster, Mounjaro has not yet been commissioned as a Local Enhanced Service (LES). This means that, for now, there is no funded or authorised pathway for GPs to prescribe or initiate tirzepatide for weight management within primary care.
The new QOF obesity indicators (OB004a and OB004b) are national requirements. They expect practices to:
However, where a medicine such as tirzepatide is not locally commissioned, practices cannot prescribe it and should not be penalised for non‑delivery. The shared decision‑making indicator still applies, but the conversation should focus on lifestyle interventions, behavioural support, and the principle that pharmacological options exist nationally but are not yet available locally.
Until commissioning is confirmed:
This approach ensures compliance with QOF while maintaining transparency about local service limitations.
Once Doncaster ICB commissions Mounjaro as a LES, practices will be able to prescribe tirzepatide for eligible cohorts under NICE guidance and integrate medication initiation into the shared decision‑making workflow. The LMC will update practices as soon as commissioning arrangements are confirmed.
In the meantime, practices should focus on accurate coding, timely referrals, and structured documentation. These remain the key elements for meeting QOF requirements and supporting patients effectively while local pathways are finalised.