REFERRAL PATHWAYS NDPP: Practices run regular searches to identify eligible patients. Patients with NDH referred via practice staff or self-register on provider website. GDM patients invited/referred via primary care or maternity services with self-referral option.

REFERRAL PATHWAYS T2DR: Referrals must be made by prescribing healthcare professionals in Primary Care due to clinical oversight (medication management/titration). Consistent across LLR and Northamptonshire.

REFERRAL PATHWAYS BSOP: Eligible individuals starting prescribed weight-loss medication referred only by prescribing primary care clinician. In Northamptonshire BSOP delivery aligns with Primary Care Weight Management (PCWM) service to integrate pathways and reduce duplication. REFERRAL PATHWAYS LTCP (LLR ONLY): Participating practices run yearly searches (Jan-Mar window) over 3-year pilot to identify eligible patients and invite by text; patients self-register online or by phone.

PLANNED ENGAGEMENT: Due to LNR IG restrictions, primary care contact details cannot be shared with providers without consent - practices encouraged to text eligible patients themselves or host provider-led patient events. Engagement extends to Integrated Neighbourhood Teams; ICB shares local health/social care events with providers, especially in deprived/diverse/underserved areas. REFERRAL OPTIONS

BY PROGRAMME: DPP/LTCP - self-registration online, by telephone or via PRISM referral form completed by any trained practice team member (ARRS, nursing, admin, social prescribers); reinforced by VCSE and public health. T2DR/BSOP - prescribing healthcare professional in primary care only.

KEY STAKEHOLDERS: Primary Care practices (key referrers); ICB; Public Health teams; community care coordinators; Weight Management Steering Group (Northants); maternity services for GDM; people with learning disabilities. COMMUNICATIONS: LLR weekly General Practice newsletter, MS Teams channel via local health informatics team, bi-weekly Primary Care Webinars and monthly Diabetes Engagement Webinars (provider drafts, ICB approves/distributes). Northants similar via Primary Care newsletter, Primary Care channel, Weight Management Steering Group and public health healthy lifestyle alignment.

F2F LOCATION PLANNING: ICB maintains comprehensive list of community locations across LLR and Northamptonshire; monthly ICB-provider meetings to review reports and target areas of high/low referral activity; provider retains autonomy to schedule/deliver community sessions based on identified need.

POPULATION GROWTH (2011-2021 vs England 6.6%): Leicester +11.7%, Rutland +9.8%, Northamptonshire +13.5%. POPULATION 2021: Leicester 368,600; Rutland 41,000; Leicestershire 712,300; North Northants 359,500; West Northants 425,700.

LANGUAGE LLR: ~30% of residents do not speak English as first language. Most common after English: Gujarati and Punjabi (large South Asian population), then Polish and Romanian (Eastern European).

LANGUAGE NORTHANTS: 6.15% of households have no adults speaking English as first language (up to 25% in some wards). Top non-English vary by N/W Northants: Polish, Romanian, Lithuanian, Hungarian, Bengali.

ETHNIC DIVERSITY LLR: Leicester one of the most ethnically diverse areas of England - 41% White, 43% Asian, remainder Black/Mixed/Other. Asian populations disproportionately represented in T2D - higher genetic risk, earlier onset, faster progression.

ETHNIC DIVERSITY NORTHANTS: Majority White British with growing minority communities; largest minority is White Other (predominantly East European); Mixed and Black communities contribute to younger age profiles.

DEPRIVATION LEICESTER: 36% of residents in most deprived deciles; life expectancy below national average; 68% of LLR's overweight/obese adult population resides in Leicester City.

DEPRIVATION LEICESTERSHIRE & RUTLAND: Variable - Harborough among least deprived nationally; Melton most deprived in the county; rurality and transport barriers.

DEPRIVATION NORTHANTS: ~140,000 residents in 20% most deprived nationally (Northampton, Wellingborough, Kettering, Corby, Daventry); 15-16 fewer healthy life years vs least deprived. High obesity prevalence: Corby, Northampton East, Northampton North. HIGH-RISK GROUPS (both systems): People with learning disabilities; early onset T2D; women with current/previous GDM; racialised minority communities; people living with multimorbidity; rural residents with limited service access.

PROVIDER EXPECTATIONS: Co-production with ICB, Public Health, VCSE, faith groups and community leaders; flexible delivery (evening/weekend, hyperlocal venues - libraries, community centres, faith settings, workplaces); population health management; multi-lingual provision (South Asian in LLR, Eastern European in Northants); culturally adapted dietary advice; alignment with Tier 2 weight management, smoking cessation, NHS Talking Therapies, hypertension case finding, community wellbeing hubs, screening/vaccination outreach.