NHS Kirklees initiated a review and redesign of weight management provision aiming to implement a person centred, evidence based, tailored service for obese people living within Kirklees. The review and redesign process involved a wide range of stakeholders including health practitioners, service users (attending weight management activity) and target groups (not attending weight management support). The outcome was the implementation of a single point access service, based on a tiered approach, for people aged 16 years or over, with a body mass index (BMI) of 30kg/m2 or above.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
To undertake a review and redesign of weight management provision to enable the implementation of a person centred, evidence based, tailored service for obese people living within Kirklees.
1. Scope existing practice and weight management provision within Kirklees.
2. Ensure target groups (service users, non service users and providers) are central to the review and redesign process and develop a deeper understanding regarding the barriers and motivations to weight loss.
3. Engage a wide range of stakeholders in the review and redesign of the services.
4. Tender and procure weight management services to meet the needs of the local population.
5. Provide weight management support in line with national policies and evidence such as NICE Guidance CG43.
Reasons for implementing your project
In Kirklees 18% of all adults are obese and 36% are overweight (Kirklees Joint Strategic Needs Assessment (JSNA), 2009). The Foresight report predicts that if current trends continue then, by 2015, 36% of males and 28% of females will be obese. By 2025, these figures are estimated to rise to 47% and 36% respectively and by 2050, 60% of males and 50% of females could be obese.
NHS Kirklees identified obesity as a major public health challenge and developed an Obesity Programme Plan to introduce a coordinated set of actions to tackle obesity. As part of this plan, which focuses on enabling people who are overweight or obese to achieve and maintain a healthy weight, NHS Kirklees recognised the need to increase the capacity and range of weight management provision to address the increasing prevalence of obesity across Kirklees.
Therefore a review and redesign of weight management provision was initiated with the aim to implement an end-to-end weight management service for people living within Kirklees aged 16 years or over with a BMI of 30kg/m2 or above who are motivated to lose weight.
How did you implement the project
The project took a bottom-up approach to service redesign. Insight was generated through consultation with: Health Practitioners. Target groups (not accessing weight management support).
Service users (undertaking weight management activity). This developed a detailed understanding of the behaviours and motivational issues related to weight management. Insight was integral to the development and implementation of the new service. Key insights:
- Adults are put off services by the humiliation of the weigh-in and people attending classes who were not seen as very overweight
- Cost is a barrier
- Men perceive weight management services as inappropriate and want material targeted at them
- Health Practitioners are happy to raise the issue but struggle to motivate behaviour change.
- Practitioners felt there were inadequate pathways/communication between primary and secondary care and did not feel anyone is taking the lead locally.
A Clinical Obesity Audit was undertaken to explore the current action in place to tackle obesity within primary care settings across Kirklees. The audit developed a better understanding of the identification, assessment, treatment and referral of obese patients.
Stakeholders were identified and an expert reference group established; a range of clinical professions and local organisations were represented. The insight and audit findings were used to develop potential care pathways. The pathways were tested with the group and the final pathway formulated. The new weight management care pathway incorporated a single point of access and a range of interventions that were previously not available in Kirklees.
Mechanisms were put in place to enable primary care professionals to play an instrumental role in the implementation of the service. An online network was then developed to enable clear communication between partners; standardised weighing and measuring equipment provided and a locally enhanced service implemented.
The insight gained from health professionals and the development of an expert reference group ensured committed partnerships were developed able to tackle obesity within Kirklees. Stakeholders were instrumental in developing a clear vision for weight management provision in Kirklees providing leadership and buy-in locally. In addition the review and redesign process ensured evidence based care pathways and referral criteria were developed providing a consistent, NICE compliant approach.
A new dedicated single point access service was implemented as a result of the review and redesign process. A range of interventions are now available that are tailored to individual needs to ensure the patient receives the most appropriate intervention for them. The service has capacity to receive 3000 new client referrals per year. This type and scale of service was previously not available in Kirklees.
The development of robust quality and performance indicators, with associated incentivised payments and service deductions, will ensure the delivery of an effective, efficient and quality service. In addition an equitable service has been established through:
- A locally enhanced service which ensures patients are identified, assessed and referred appropriately.
- Services provided in accessible settings that are appropriate for the target audience and are offered at convenient times (based on the insight).
By developing quality insight driven services with regular user involvement it is anticipated that the service will provide improved customer experience, satisfaction and retention rates.
The service in the long term has the potential to realise substantial savings; there will be savings made from decreased GP visits, drug treatments, surgery and long term support. We have also identified that there would be significant savings through the prevention of diseases associated with obesity.
Key learning points
- Create an environment for constructive debate and challenge.
- Give stakeholders the opportunity to shape and develop services; the time invested in this meant minimal time was needed to promote the service after its launch and maximum buy-in was achieved.
- Scope existing practice to identify gaps, avoid duplication and ensure a joined up approach is taken.
- Listen to your target audience and keep revisiting the insight with stakeholders, this will ensure you develop a tailored and person centred service.
- Develop a clear evaluation framework; collect robust baseline data, develop clear outcome measures and build this in from the start of the process.
- Ensure referral processes are clear, straight forward and are developed with stakeholder input.
- Encourage continuous feedback from stakeholders during the implementation phase of the project via mechanisms such as an online network or forum.
Health Improvement Practitioner Advanced
Is the example industry-sponsored in any way?