❓FAQs

OB004

Does a new qualifying BMI restart the 90-day referral window?

Recording a new qualifying BMI during the QOF year starts a new 90-day referral window. If the original 90-day period was missed, a new qualifying BMI allows another opportunity to make the referral within the required timeframe.

If a patient has already been referred, do they need another referral if a new BMI is recorded?

No. Once an appropriate referral has been recorded within 90 days of a qualifying BMI, the patient is counted as complete for the remainder of the QOF year. They do not need to be referred again simply because another BMI is recorded.

Which weight management service should patients be referred to?

Practices should follow their local referral pathway. Depending on local commissioning arrangements, this may include the NHS Digital Weight Management Programme, Local Authority Weight Management Services, or other commissioned services. Where the local pathway is patient self-referral, recording the referral when directing the patient to self-refer is considered appropriate.

Which referral codes count?

The QOF business rules recognise the following referral codes:

• Referral to Weight Management Service

• Referral to NHS Digital Weight Management Programme

• Referral to Local Authority Weight Management Programme

• Referral to NHS Diabetes Prevention Programme (where appropriate)

• Referral to Total Diet Replacement Programme

These are all included within the Ardens templates.

Does advice alone count, or does there have to be a referral?

A referral must be recorded. Advice or lifestyle counselling alone does not achieve the indicator.

If a patient's BMI later falls below the referral threshold, can they be exception coded?

A subsequent lower BMI does not remove the qualifying BMI that triggered the indicator.

For this indicator, a valid weight management referral (or an appropriate exception, where applicable) should be recorded within 90 days of the qualifying BMI. Practices should apply the QOF business rules based on the patient's clinical circumstances and use their clinical judgement when determining whether exception coding is appropriate.

Does the patient need an obesity diagnosis code to qualify?

No. Eligibility for the obesity indicators is based on BMI and the QOF criteria. A diagnosis code for obesity is not required.

Does SMS/text signposting count as a referral for OB004?

If a patient has been signposted to a structured weight management programme (e.g. via text message) and subsequently self-refers, a self-referral code can be recorded. The key requirement is that there has been a shared decision-making conversation or signposting discussion, and the patient has engaged with or been directed to a programme. Record the referral using the appropriate code in the Ardens template.

Are the BMI thresholds different for patients from Black, Asian and Minority Ethnic backgrounds?

Yes. For OBES_REG (OB004), the qualifying BMI is 30 or above generally, or 27.5 or above for patients from BAME backgrounds. For OBES2_REG (OB005), the qualifying BMI is 35 or above generally, or 32.5 or above for BAME patients. Ethnicity must be recorded in the patient's record for these lower thresholds to apply in the searches.

OB005

What should we do for patients already using private weight loss medication?

If private weight loss medication is recorded in the patient's medical record, this should remove them from the OB005 denominator where appropriate. For OB004, referral should still be offered if clinically appropriate. If the patient declines because they are already receiving private treatment, record the decline in their medical record.

Does OB005 require all three components within the same 12-month period?

Yes. All three components (shared decision-making discussion, offer of NICE-approved medicines management, and referral to a behavioural support programme) must be recorded within the last 12 months. Even if a patient is already prescribed medication such as tirzepatide (Mounjaro), they will remain on the outstanding list until all three codes are recorded within that timeframe.

What's the difference between OB005 and the Obesity Medication Pathway cohorts?

OB005 is a QOF indicator requiring three coded actions for patients on the OBES2_REG. The Obesity Medication Pathway (OMP) is a separate NHS programme with its own eligibility cohorts for prescribing weight loss medication. The searches for each are in different folders. A patient may be eligible for both, but meeting one does not satisfy the other.

General

If a patient declines referral or doesn't respond to invitations, do we keep inviting them?

No. A recorded decline only needs to be entered once. Personalised Care Adjustment (PCA) invitation codes are also available where patients do not respond following the appropriate invitation process.

Why do my Ardens searches show different patient numbers (Outstanding, Time Sensitive and Manager)?

The searches have different purposes:

• Outstanding shows all eligible patients who may still require work.

• Time Sensitive shows patients whose 90-day referral window is approaching expiry.

• Ardens Manager reflects overall QOF achievement, so the numbers will not necessarily match.

Can OB004 and OB005 be completed at the same consultation?

Yes. There is no requirement to wait until a referral has been accepted or completed. If all relevant discussions have taken place and the appropriate coding has been recorded, both indicators can be completed during the same consultation where appropriate.

What Personalised Care Adjustment (PCA) / exception codes are available?

PCA codes allow practices to exception report patients where the indicator is not clinically appropriate or where the patient has made an informed decision not to engage. The Ardens QOF Obesity template includes all available PCA options for OB004 and OB005, including codes for service not available, patient declined, and patient unsuitable. Ensure you are using the latest template version, as new exception codes were added in the 2026/27 update.

SystmOne: Why does the Patient Status Alert icon open the best practice template, not the QOF template?

The scales icon in the Patient Status Alerts area opens the Ardens clinical (best practice) Obesity template. To access the QOF template from there, click the red star within the best practice template, which links through to the QOF-specific page. The QOF template can also be accessed directly via Auto-Consultations > ardens CONTRACTS > QOF Obesity.