Question 1

Yes. This is in the process of being updated in the light of the planned implementation of the NHSE Interim Commissioning guidance on Tirzepatide. The ICB is rolling out prescribing via primary care services to
three cohorts of patients over three years (2025 – 2028) in line with NHS
England funding and this guidance. 

Eligibility criteria differs across the cohorts as follows, and eligible patients are identified via their GP records:

• Cohort 1 – Patients must have a body mass index (BMI) of 40 or higher and four or more of the following comorbidities: hypertension, dyslipideamia, obstructive sleep apnoea, cardiovascular disease, type 2 diabetes mellitus 

• Cohort 2 - Patients must have a body mass index (BMI) between 35 and 39.9 and four or more of the following comorbidities: hypertension, dyslipideamia, obstructive sleep apnoea, cardiovascular disease, type 2 diabetes mellitus

• Cohort 3 - Patients must have a body mass index (BMI) of 40 or higher and three or more of the following comorbidities: hypertension, dyslipideamia, obstructive sleep apnoea, cardiovascular disease, type 2 diabetes mellitus.

Please note: The BMI threshold is reduced by 2.5 kg/m² for people from South Asian, Chinese, other Asian, Middle Eastern, Black African, or African
Caribbean ethnic backgrounds.

In relation to timeframe, whilst NICE required roll out to commence in June
2025, the late issuing of NHSE commissioning guidance to ICBs and the need for the ICB to commission a primary care delivery model has meant roll out in Birmingham and Solihull (BSOL) will commence during November 2025 for eligible patients. This timeline is similar to other ICBs implementing this model.  

Question 2

Birmingham and Solihull (BSoL) has two Tier 3 specialist weight management services delivered by University Hospitals Birmingham NHS Foundation Trust (UHB) and Birmingham Community Healthcare Foundation Trust (BCHC) respectively. These are not commissioned by the ICB.  The ICB with Public Health leads from Birmingham and Solihull have established a system Obesity Group which is tasked with developing an agreed integrated obesity model and pathways for the future. 

The ICB does hold information patient demographics on BSOL referrals into
the NHS Digital Weight Management Service (Tier 2) and these have been
included for April 2024 to March 2025: Note suppression rules have been applied. Referral counts under 8 shown as * and all other values rounded to nearest 5. For other weight management tiers and services, we advise the requestor to contact the provider directly.

a) IMD
1 -2520
2 -775
3 - 520
4 - 225
5 - 155
Unknown - 60 

b) Ethnicity

Asian or Asian British - Any other Asian background 115
Asian or Asian British - Bangladeshi 105
Asian or Asian British - Chinese 10
Asian or Asian British - Indian 305
Asian or Asian British - Pakistani 610
Black, African, Caribbean or Black British - African 265
Black, African, Caribbean or Black British - Any other Black background 115
Black, African, Caribbean or Black British - Caribbean 315
Mixed or Multiple ethnic groups - Any other mixed background 30
Mixed or Multiple ethnic groups - White and Asian 10
Mixed or Multiple ethnic groups - White and Black African 15
Mixed or Multiple ethnic groups - White and Black Caribbean 50
Other Ethnicity - Any other ethnic group 135
Unknown 90
White - Any other white background 220
White – British 1820
White – Irish 35 

c) Age

10-19 10
20-29  175
30-39 480
40-49  830
50-59 1220
60-69  1055
70-79 415
80-89  60
90-99 * 

d) Sex

Female 2665
Male 1585 

Question 3

The ICB does not commission any weight management services in
Neighbourhood Health Centres. The ICB is currently commissioning Tirzepatide in line with Year 1 of NHSE Interim Commissioning Guidance.  This involves a primary care delivery model that will see eligible patients being treated at either a PCN /practice level. Year 1 numbers are in the region of 500 patients across Birmingham & Solihull (BSOL), however numbers are expected to increase significantly in future years and any future delivery model will need to consider the opportunity a neighbourhood health approach presents. 

Question 4

 The ICB has no specific funding allocation for adult weight management services.  The ICB has received a NHSE financial allocation for the roll out of the NICE TA 1026 – Tirzepatide during 25/26. The ICB will commission in line with NHSE Interim Commissioning Guidance and allocated funding will be ring-fenced.