BNSSG REFERRAL PATHWAYS - DPP: All eligible patients can be referred; patients can self-register if they meet criteria; practices refer directly to the provider by email using the DPP template. T2DR: GP referral using the EMIS referral form sent to the provider via email. BSOP: GP referral when prescribing tirzepatide using the provider referral form on EMIS, sent via email.

BNSSG ENGAGEMENT: Engage directly with practices, PCN leads and the One Care Clinical Lead for Long Term Health.

BNSSG REDUCING BURDEN: Integrate referral forms/processes within EMIS; monitor take-up/compliance to identify groups not engaging; support PCNs/practices with case-finding; agree F2F locations with ICB localities, One Care and PCN Leads. GLOUCESTERSHIRE: ICB expects providers to operate as part of an integrated, neighbourhood-based partnership with community pharmacies and specialist teams; engage proactively with practices while minimising workload.

NHS DPP: Primary care identifies via clinical-system searches or opportunistic NDH assessment; refers with consent or invites self-referral via approved digital/written channels. T2DR: Primary care identifies and refers eligible adults with T2D meeting national criteria using the approved referral mechanism; ICB to work with provider to optimise coding and referral quality given current variation across practices. BSOP: Referrals from General Practice when patients are prescribed tirzepatide for obesity.

F2F LOCATIONS: Use ICB risk stratification (deprivation, rurality, BMI, unmet need); collaborate with place-based care navigators across the ICB's six locality-based neighbourhood hubs and community 'spokes' (GP surgeries, pharmacies, community centres, VCSE venues); prioritise high-need/underserved/deprived/rural communities; co-design with local communities and review using uptake/attendance data.

BNSSG LANGUAGES: Bristol - 89.9% of residents (3+) speak English as main language (below E&W average); next most common as a main language are Polish (1.5%), Spanish, Somali, Romanian, Arabic, Italian. North Somerset - 2.4% of households (2,259) have nobody for whom English is a main language; South Gloucestershire - 2.9% of households.

BNSSG GOVERNANCE: Provider links with the ICB's Strategic Health Inequalities, Prevention and Population Health Committee (SHIPPH); engage directly with local communities, voluntary sector and patient groups.

BNSSG DEPRIVED NEIGHBOURHOODS: Knowle West, Hartcliffe and Withywood (Bristol), Weston-super-Mare (especially South Ward and Central).

BNSSG MOST DEPRIVED IMD AREAS: Bristol - Lawrence Hill, Filwood, Easton, St Pauls, Southmead; North Somerset - Bournville; South Gloucestershire - Kingswood, Staple Hill, Patchway.

GLOUCESTERSHIRE DEPRIVATION/DIABETES HOTSPOTS: Gloucester city (multiple LSOAs in top 10-20% deprivation nationally); West Cheltenham (e.g. Hesters Way, Springbank); Forest of Dean pockets (transport barriers and poor access).

GLOUCESTERSHIRE LANGUAGES & ETHNICITY: English is main language; wide range spoken across the county; Gloucester city has pockets of significant linguistic diversity - large Eastern European communities (higher risk of late presentation) and South Asian/other minority communities (disproportionately higher T2D rates). Minority ethnic population ~12.3%, concentrated in Gloucester and Cheltenham.

GLOUCESTERSHIRE BARRIERS: Rural residents and those with low confidence in digital tools; community diabetes services already deliver education/clinics including outreach to housebound patients - ICB will work with provider to coordinate.