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With Tier 2 weight-management services cut back in many areas, more people go straight to medication. Leading a team of dietitians across primary care, I'm seeing more of these patients triaged straight to us, and that trend isn't going away. Media coverage isn't slowing down, and neither is patient demand.
That shift is worth leaning into. When a patient books straight in with a dietitian, we can cover a lot in one appointment. Is a private purchase safe and appropriate? What does an NHS referral pathway look like, and do they meet it? What non-medication approaches exist alongside or instead of a prescription? We can refer them on to Tier 3 weight-management services on behalf of the GP, face-to-face or digital, depending on local availability. We can talk through cost and which medication might suit them best. None of that needs a GP slot, freeing GPs to focus on what only they can do.

QOF changes for 2026/27 make this more than a nice-to-have. Two new obesity indicators ask practices to refer 10–30% of adults living with obesity to a weight-management programme within 90 days of a BMI recording, and to document shared decision-making conversations covering treatment options, medicines, behavioural support and patient preference. Dietitians are well placed to deliver and record exactly that.

Scale that up and the numbers get serious: around 30% of adults in England are living with obesity, and almost 6 million people across the UK are living with diabetes, diagnosed or not. In a typical neighbourhood of 50,000 people, that works out to roughly 12,000 adults with obesity and 4,400 with diabetes.

It would be a mistake to file dietitians under "obesity clinic" and leave it there. The same skills apply to dietitians supporting diabetes, gastrointestinal conditions, frailty, fertility discussions, menopause, and general nutrition in adults and paediatrics. All of this sits squarely inside what neighbourhood teams are meant to cover. We work alongside social prescribers and other neighbourhood-team roles, taking on the more complex cases they can't manage, training the wider team to spot nutrition risk early, and helping build joined-up pathways where none existed before.

Here's my prediction for the year ahead. As primary care reorganises into neighbourhood teams, the gap will be patients who fall outside the tidy criteria: those who don't speak English as a first language, those facing wider socio-economic barriers, those who don't fit a neat BMI or comorbidity threshold, or those for whom BSOP won't work either. It's not just new patients: patients coming off Tier 3 GLP-1 medications are already discharged straight back to GPs with no handover, left picking up care they were never resourced or trained for. That trickle will only grow. This is a health inequality issue as much as a capacity one. A practice with a dietitian in its PCN team will bridge that gap; one without, will feel it as a growing bottleneck, exactly where it can least afford it.

Got thoughts on what a dietitian could look like in your team, or want to explore it? Get in touch. Find out more at www.primarycaredietitians.co.uk.