REFERRAL PATHWAYS NDPP (BOB): Identification via GP clinical systems using national NDPP criteria and opportunistically through NHS Health Checks. Routes include nationally commissioned provider one-to-one digital/F2F, GP referral, embedding in local Tier 2/Integrated Lifestyle Services where commissioned, self-referral with HbA1c/GDM evidence, and signposting from community midwives (GDM). REFERRAL PATHWAYS NDPP (FRIMLEY): Identification via GP systems and NHS Health Checks; direct GP referral aligned with Frimley prevention/diabetes pathways with routine reporting to referrers. REFERRAL PATHWAYS T2DR (BOB): Identification via GP searches and opportunistic referral at diabetes reviews; oversight at IDDN, WM Steering Group and Clinical Programme Board. Practices currently receive £100 per patient started (subject to continuation). REFERRAL PATHWAYS T2DR (FRIMLEY): System-level searches and clinical review; nationally commissioned provider; oversight via Frimley Diabetes Programme Board.

REFERRAL PATHWAYS BSOP: Triggered following GP initiation of tirzepatide via the Obesity Locally Commissioned Service (LCS) - mandatory referral to BSOP provider as wrap-around support; SNOMED-coded feedback to primary care. STAKEHOLDERS: GP practices and PCNs; community midwives and diabetes hospital doctors/midwives for GDM; ICB Primary Care, Diabetes and Healthy Weight leads; Medicines Optimisation and Prescribing teams; existing weight management and LA-commissioned lifestyle services; hospital dietetics; community/VCSE partners; secondary care diabetes and obesity services.

REDUCING PRIMARY CARE BURDEN: Simple referral mechanisms aligned to existing clinical system platforms with clear inclusion/exclusion criteria; clear de-prescribing guidance for T2DR aligned with Thames Valley ICB formularies; clear patient-facing information; robust SNOMED-coded feedback to practices; provider takes responsibility for engagement, onboarding and retention.

F2F LOCATION PLANNING: Provider proactively scopes local F2F opportunities with clear community engagement strategy; uses population health and deprivation data to propose priority locations; aligns F2F with existing NDPP/T2DR community venues where possible.

KEY LANGUAGES: Across Thames Valley - Urdu, Hindi, Punjabi, Polish, Nepali. FRIMLEY: Slough particularly diverse - ~30% report a main language other than English; Punjabi 6.0%, Polish 4.9%, Urdu 4.1%, plus Hindi and Nepali. BOB: Reading top non-English Polish (1.2%), Nepalese (1.2%), Urdu (0.4%); Oxford Portuguese (0.8%), Spanish (0.7%), Polish (0.7%) - collectively ~one-fifth of residents in both towns have a main language other than English.

ETHNIC/CULTURAL COMMUNITIES NEEDING TAILORING: South Asian communities; Black African and Black Caribbean communities; Nepalese communities (notably in Frimley) - more likely to develop T2D at younger ages and lower BMI thresholds with cultural, linguistic or digital barriers.

PRIORITY GROUPS: People in higher deprivation (Core20); people with learning disabilities; people with severe mental illness; some minority ethnic communities; individuals experiencing social isolation or low activation.

CORE20PLUS5 ALIGNMENT: Focus outreach and F2F provision in higher deprivation areas; support equitable access to behavioural support alongside pharmacological treatment; monitor uptake and outcomes by deprivation and protected characteristics; collaborate with public health and VCSE partners.

EXISTING SUPPORT: LA-commissioned Tier 2 and integrated lifestyle services (variable by place); nationally commissioned Healthier You programmes; primary care-led obesity pharmacotherapy pathways; community/VCSE provision.