Specialist Weight Management Service
Second Nature is now available to your patients via NHS Right to Choose. Find your local eligibility criteria, referral forms, and everything you need to get started.
Eligibility criteria
*For people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, the qualifying BMIs are 2.5 kg/m² lower (e.g. 37.5 kg/m² instead of 40 kg/m²).
The patient has a BMI ≥ 40 kg/m²* AND Type 2 Diabetes and one of the following:
Inadequate Control (HBA1c >64mmol/mol) on maximal oral therapy
Presence of nephropathy (eGFR <45 OR Albumin: Creatinine ratio >10mg/mmol)
Metabolic dysfunction associated Steatohepatitis (MASH - aka as NASH)
Onset of diabetes under the age of 40 years old
Insulin resistance (> 2 units/kg/day)
The patient has a BMI ≥ 35 kg/m²* AND is requiring time-sensitive surgery/procedure such as:
Organ transplant
Arthroplasty because of immobility
Spinal surgery
Cardiac surgery
Cancer surgery
Limb or sight saving surgery
Abdominal wall hernia repair
Fertility treatment
The above list is not restrictive and subject to discretion of the MDT team.
The patient has a BMI ≥ 40 kg/m²* AND has two or more weight related co-morbidities
Complete list of co-morbidities – please indicate relevant below:
BMI ≥ 50 kg/m²*
Sleep apnoea requiring CPAP
Systolic or diastolic cardiac dysfunction (i.e. heart failure)
Resistant hypertension (3 or more blood pressure tablets)
Idiopathic intracranial hypertension
Metabolic dysfunction associated Steatohepatitis (MASH – aka NASH)
Atrial fibrillation
The patient has any rare or monogenic condition where bariatric surgery or drug intervention has been shown to provide significant clinical benefit. Please note, these will be assessed on an individual basis.
In addition to the routes above, the referred patient also has to meet these eligibility requirements.
You have assessed the patient is ready or motivated to change and that they are fully committed to participating in the Second Nature T3 programme.
The patient is medically stable and that they do not require further investigation for an existing or new health condition.
Tier 1 and 2 community interventions have been tried and failed, for a minimum period of 2 years.
You have supported the patient in a co-ordinated way for Tier 2 for at least 2 years and have undertaken a face-to-face consultation with the patient prior to this referral to a Tier 3 Weight
Exclusion criteria
Do not refer if any of the following apply:
• Under the age of 18 years.
• Pregnant or breastfeeding.
• Uncontrolled hypertension / heart condition.
• Active or suspected, untreated eating disorders, including binge eating disorder, purging within the last 3 months.
• Active cancer.
• Bariatric surgery in the past two years.
• Unstable or severe mental illness, including suicide attempts in the past 12 months, patients who have self-harmed in the past 3 months, or suicidal ideation in the last 3 months. This may prevent engagement with the behaviour change programme.
• Unstable alcohol or drug use (can be referred if the patient has received support and been in recovery for 3 months).
• Unstable hypothyroidism (can be referred if stable).
• Unstable Cushing’s syndrome (can be referred if stable).
Two pathways, both consultant-led.
We assess each patient and personalise their care.
Our specialist team includes consultant physicians, specialist dietitians, health psychologists, pharmacists, nurses and exercise specialists.
Consultant-led MDT. GLP-1 prescribing (Wegovy) where clinically appropriate. Dietetic, psychological, and behavioural support for up to 24 months.
Consultant-led MDT. Dietetics, psychology, exercise support. Structured lifestyle programme for 12 months.
Refer to us
Referrals can be submitted via NHS e-RS or directly by NHS mail. Follow the steps below for your area.
1
If you can't import files into your clinical system, download the .docx referral form and complete it as a Word document.
Using Ardens, DXS or another local form management system?
Check there first; if we're not listed yet, ask your file management lead to add this form.
2
If you have a question about the referral process, contact
Matt Reid (Partnerships Associate) at matthew.reid@secondnature.io or call 07540235288.
