REFERRAL PATHWAYS: Provider must integrate with existing diabetes and weight management services and signpost to additional lifestyle support (council-run weight loss/Tier 2, exercise programmes, social prescriber referrals, community pharmacy services, smoking cessation). Implement digital referral flows with standardised SNOMED/READ coding to reduce admin burden. Provide regular feedback to referrers and ICB - format/frequency agreed at mobilisation. Note: Derby & Derbyshire LA Tier 2 weight management services accessible via GP or self-referral. STAKEHOLDERS: All GP practices and PCNs across the cluster; GP Practice Diabetes Leads and ARRS roles (Social Prescribers, Health and Wellbeing Coaches); Healthier You Delivery Group (monthly monitoring/assurance); Community Health Teams (Community Diabetes Specialist Nursing, Dietetics, Pharmacy); Weight Management specialist clinicians and Task and Finish Group; Voluntary Sector for under-represented groups; Local Authorities and Public Health Teams; Community Health Services for structured education; other health providers for cross-referrals.

REDUCING PRIMARY CARE BURDEN: Pre-populated referral forms integrated into GP systems; multiple referral options via integrated clinical systems (community pharmacies, GP practices, additional weight management); Data Sharing Agreements so providers contact patients directly; clear progress letters confirming enrolment, progress and completion (BSOP needs clear channel to inform GP if patients stop attending); standardised coding with digital integration into patient record; regular training for practice teams; concise user-friendly materials including Easy Read, FAQs, referral toolkits and local Healthier You website; share data and case studies.

F2F LOCATION PLANNING: Locate core course venues within each PCN/Place-based partnership proportionate to population size, need and demand; consider rural locations and transport; align with NHS 10-Year Plan strategic shift 'moving care from hospitals to community settings'; Universal Proportionalism framework against needs driven by Joint Intelligence Data Set.

KEY LANGUAGES: Derby & Derbyshire - Polish, Punjabi, Urdu, Romanian, Slovak; BSL for 1,500+. Lincolnshire - Polish, Lithuanian, Romanian, Russian, Latvian, Bulgarian. Nottinghamshire - Urdu, Polish, Punjabi, Arabic, Romanian.

ACCESS BARRIERS: Derby & Derbyshire - rurality and varied service needs. Lincolnshire - seasonal employment, entrenched health inequalities, ageing population, migrant workforce. Nottinghamshire - rurality and varied service needs.

DIGITAL EXCLUSION: Older adults, rural communities, those with disabilities or financial hardship; in Lincolnshire significant exclusion among older adults (193,532), low-income (147,800), non-English speakers (66,807), coastal/rural deprived. ETHNIC/CULTURAL: Derby City focus on PCNs with culturally sensitive engagement; Lincolnshire migrant communities (poor English skills 1.3%, no English 0.2%) require multilingual resources and proactive engagement; Nottinghamshire has South Asian, Black African-Caribbean, Eastern European and Traveller communities requiring co-design with community leaders.

PRIORITY GROUPS: Ethnic minorities (culturally appropriate outreach, T2DR products); Eastern European migrants (Polish, Romanian, Slovak); agricultural and food-processing workforce (flexible appointments, workplace outreach); rural and coastal communities (mobile outreach, community-based sessions); Gypsy, Roma and Traveller (trusted advocates, culturally sensitive education); migrant and seasonal workers in coastal/rural areas; pregnant women with GDM/history of GDM; people with SMI or LD; neurodiversity; rural and digitally excluded populations.

ACCESSIBLE MATERIALS: Easy Read, visual aids, BSL interpreters for Deaf community, Braille for visually impaired, both digital and paper formats.