To develop an evidence-based adult obesity care pathway collaboratively across NHS Bassetlaw Primary Care General Practices and to ensure successful implementation and evaluation of the pathway within primary care. The evaluation of the effectiveness of implementing the care pathway using qualitative and quantitative methods should lead to identifying ways to improve the care pathway further.
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
The Aim of the initiative is to provide an easily accessible, credible and recognisable service for overweight Adults in Bassetlaw that is beneficial and helps to support them in making lifestyle improvements that will improve their longer term health. The service was designed to follow the guidance as set out in notes CG43. In addition we wanted the service to meet and exceed the requirements set out in the local NHS Bassetlaw Enhanced Service Specification. Staff selection and accredited training were a key element of the service. We also wanted to provide a service that patients were aware of, knew how to access, was valued, and one that demonstrated a long term and sustainable health benefit. Through the passage of time we wanted to extend the access of the service by offering it to other General Practices in Bassetlaw, and also to look at the potential to extend beyond Bassetlaw. As such we developed a standard service pack and supporting educational materials available to each course leader. We set out to liaise closely with NHS Bassetlaw's Public Health team and to share our knowledge and expertise, by regular and systematic audits of our progress. This was also combined with regular and systematic service reviews with delivery staff. These review processes were important in our service reviews and development, so that we might achieve better results. In addition we set out to develop working partnerships with local organisations such as district council leisure facilities and voluntary sector organisations. We also wanted to have a multidisciplinary team that could be innovative in its approach to the service design.
To develop an evidence-based Adult obesity care pathway in-line with CG 43 and the NHS Bassetlaw Local Enhanced Specification
2. To develop a service that has long-term sustainable benefits for patients by ensuring we conduct 3 and 12 months follow ups
3. To develop a service that has better outcomes than any other comparable service locally
4. To develop a service brand and identity that would be instantly recognisable locally
5. To ensure staff were recruited and trained to deliver services to high standards
6. To provide choice of access to the service by offering different days, times and locations of delivery
7. To develop an effective patient communications and feedback system
8. To evaluate the effectiveness of the pathway, with regular audits and reviews with public health lead and delivery personnel
9. To develop an independent academic assessment of the service and to promote opportunities for academic studies, placements and evaluation, and to gain independent recognition
10. To identify service improvements from regular audits and to implement these
11. To expand the service delivery from an initial area covering 4 general practices
12. To consider innovations in service delivery
13. Identify key success factors for further implementation in other regions and areas
14. To seek partnerships with other organisations to help support lifestyle improvements
15. To maximise the opportunities for meeting the QIPP agenda
16. To involve staff and patients in improving services
Reasons for implementing your project
Obesity is a problem was seen as a major priority. Local Area Agreements & the Bassetlaw Strategic Partnership for Health (2009-2011) cite the need to try to tackle this. Part of the Bassetlaw Local Strategic Partnership (BLSP) planned objectives and actions to reduce obesity is to supply the development of initiatives to help people to lose weight and /or maintain weight. As a result an accredited weight management programme has been developed, so that Clinical staff can participate in this programme with a view to developing evidence based weight management programmes. Tangible measures and outcomes form part of the BLSP.
The PCT launched a Locally Enhanced Service (LES) at the end of 2008 to encourage Primary Care providers to develop accredited weight management group programmes of excellence to help to address the problem. During a baseline assessment a number of key problem areas were identified: service provision varied across the PCT and within general practice. Staff were often not trained, services under resourced and over-referred (e.g. dietetics), and in some cases not provided at all or provided very inefficiently e.g. 1 to 1 clinics. The management of patients was not systematic and structured, there was a lack of audit information about clinic results. Patients were not provided with first line advice prior to drug treatment.
An obesity care pathway was developed to translate the NICE guidance into a local service, which could be implemented and audited within primary care. As a result a collaborative approach to service delivery was developed to provide more patient choice, a more efficient service and one with clear audited results and regular reviews.
How did you implement the project
1. We set up a multidisciplinary team consisting of a GP, Business Manager, 2 Practice Nurses & front line reception team leader.
2. We developed brand & corporate identity for the service & called it Chrysalis
3. We developed communications materials for promotion through clinicians (GPs, Nurses), & information leaflets for patients
4. We developed a structured presentation based programme for small groups to attend over a 12 week period, and set up administration to capture patient interest. We devised a patient education pack & personal plan to provide information and support for the 12 weeks of the programme. This was developed to meet the requirements of the NHS Bassetlaw LES and CG43. We devised appropriate data capture for monitoring patient attendance and weight loss progress, as well as post programme follow up.
5. Pre-assessment appointments were set up for patients eligibility and motivation/willingness to change and for baseline data.
6. We identified rooms and appropriate staff for delivery and equipment for small groups to attend.
7. We started a pilot group of 10 patients and reviewed each session, progress and materials.
8. Due to the success & interest in the course we soon had a patient waiting list and had to recruit and train new staff as we had difficulties with existing staff to provide the required capacity.
9. We offered a range of days/times for patients to attend including evenings
10. We reviewed results quarterly & communicated these to public health teams.
11. We developed partnerships with local leisure centres to provide opportunities for exercise, delivered by our course leaders.
12. We got funding for an online calorie comparator, for additional support for patients.
13. We submitted an 18 month review to NHS Alliance & won a national award for local health improvement, & developed links with Lincoln University.
14. Costs were time setting up the programme, promotional materials, equipment, handouts/course materials
1. All enquiries are captured, & at pre-assessment baseline data was captured. This included demographics, weight, height, BMI, Blood results, BP and relevant medical history. Attendance at each session & weights are recorded. At the end of each course patient satisfaction is monitored, & we record why patients did not attend sessions or drop out.
2. Quarterly analysis of results is reported back to practices & public health. This includes demographics, attendance, weight loss, & satisfaction
3. After 2 ½ years we have seen over 1400 patients. 80% of these attend 6 or more of the 12 sessions, 65% of these achieve a 5% weight loss over the 12 week programme (av. 11.2lbs lost). After 12 months 71% of (250 Patients seen) who attended the course are at a lower weight than when they started the course, & 50% have either maintained the total weight loss or gone on to lose more weight.
4. Service now extends to 7 practices
5. Patient feedback for the service is excellent, especially when compared to other group weight loss intervention programmes
6. An independent service evaluation was done by Lincoln University, which confirms Patient success & satisfaction.
7. We have launched an online calorie comparator, & patients registering are achieving better results than average, exceeding our expectations.
8. We have launched targeted groups for patients with a BMI over 40 & learning disabilities, following our audits, which showed these groups performed less well. We will extend this to men & young people under the age of 30
9. Compared to previous groups of this kind, weight loss is double that previously achieved. There is a lack of data historically about whether this was sustained after 12 months. In terms of staff, utilisation has improved by 200%+, providing more effective use of resources. Individually patients have reported being much healthier, improving blood cholesterol and BP as well as lowering BMI on average between 1.5 and 2.0 over the 12 weeks.
Key learning points
1. Patient communications about services are vitally important. Clinicians have much
to deal with, when seeing patients, so making them aware as well as
clinicians is important. Messages need to be refreshed and revisited
frequently. Using system templates to flag up eligible patients is helpful
2. The service design is best achieved with a multidisciplinary team to ensure it
meets the requirements of CG43 and the local NHS/practice needs
3. Branding of the service has been very important as Patients like the club/social feel of our groups. They are proud also to be associated with a successful service.
4. Staff training and selection is key-our course leaders lead a healthy life and are active, so are good, credible role models. Provide activity opportunities.
5. Motivation and confidence to change are important to check with patients are ready for change. Our pre-assessment appointment is a key element of the service, and this is best done by staff that deliver the programme and understand it. Otherwise patients are uninformed, questions not comprehensively answered and drop out rates go up.
6. Clear and simple data capture at pre-assessment and during the running of programmes is important.
7. Patients need a choice of days and times to attend
8. Feedback on how individuals and group progress (anonymous) is helpful in maintaining motivation. Recognition of success (eg certificates of achievement are helpful)
9. Good administrative back up is essential in maintaining attendance levels, and ensuring that Patients return for 3 and 12 month follow ups.
10. Regular audits of progress and feedback to commissioners & public health teams is important as well as for clinicians. Independent recognition has value. This can be a valuable source for good public relations.
11. Online and accessible information is a valuable support.
12. Segmenting patients into targeted groups e.g. young people, BMI over 40 gives better results
Is the example industry-sponsored in any way?