Leading Change

General Practice Nurses at The Old Forge Surgery successfully redesigned their weight management programmes to better meet the needs of their patients and rural local population.

Where to look

The Old Forge Surgery serves approximately 2,700 patients and has two GPs and three part-time practice nurses. In preparing for a CQC visit, the nurses identified unwarranted variation in the delivery of weight management services and that patient outcomes, such as weight loss, were lower than expected.

What to change

Before the change, regular weight management advice and weigh-ins were held fortnightly or monthly within surgery hours. Feedback from patients was that this was not always suitable for those who work. Patients were noted to be under the care of weight management services for long periods of time without significant weight loss. The nursing team also had anecdotal evidence that the rural nature of the practice was a barrier to attending commercial slimming groups, all of which were in town, ten miles away. They decided to adopt a new approach to address these unwarranted variations and improve outcomes for their patients.

How to change

The nurses developed and delivered a new structured programme of weight loss advice, with weekly sessions held after surgery hours to support attendance. They used the NHS website to inform their programme, but with adaptations to suit their patients’ needs.

Nurses put up a poster in the waiting room to assess interest in an evening group. Within a week, more than 15 patients had expressed an interest, demonstrating a clear need.

The redesigned programme operates on a 12-week rolling basis, with a clear programme schedule which sets out which resources are shared with patients at each session. Within this standardised approach there is also the flexibility to personalise interaction with patients to meet their individual needs. The programme provides patients with an opportunity to socialise and share experiences, weight loss tips and general advice on healthy living with the support of the nursing team. An evaluation was undertaken at week 6 with patients, to see how they felt the programme was supporting them, along with a review of attendance numbers and weight loss figures to gauge the impact of the new service.

Adding value

• Better outcomes – Although in the early stages, indications are that all patients who have engaged effectively with the group regularly have lost weight. The programme has increased their knowledge, to support informed healthy behaviour choices. The weight management programme has been popular throughout the community and roll out continues. Currently, there are 28 patients on the programme, with approximately 16 patients attending at any one session. A recent audit of the programme found that 25 people have successfully lost weight, with only 3 having gained weight, the maximum gain being 1.8kg over a long time period. The greatest personal weight loss to date has been 17kg, with others losing around 8-9kg. Most of the patients who attend the weight management group had previously been steadily gaining weight for years so the nurses are clear that not only weight loss but not gaining weight is a success.
• Better experience – The out-of-hours timings have been effective in making the programme accessible and attendance figures have remained high. Evaluation is ongoing, but initial responses from patients have been positive. Peer support has been an important factor and readily welcomed by the groups.
• Better use of resources – The effectiveness of the programme has increased efficiency – not least, because weight management is now addressed within a group, rather than with individual patients. The practice already had most of the necessary weight loss materials, but hadn’t been sharing them with patients in a consistent way. The new programme has addressed that. Having time during the group sessions to go through the materials has helped to reinforce the information provided. The nurses continue to hand out printed resources from the NHS website and the British Heart Foundation on healthy eating and the patients have commented that this has helped them to stay focused. It also provides the nurse team with a structure of what to talk about each week to again reduce the risk of unwarranted variation in the future.

Challenges and lessons learnt

The nurses suggested that doing something different can be daunting, but rewarding; “go for it – don’t just assume that because something hasn’t been done before, it won’t work. It simply may not have been thought of before”.

Putting in the work at the beginning has proved to be time well spent. Being organised at the outset has meant that there has been little preparation to do for group meetings. Having a full programme to follow, with instruction on which handouts to give when, has also ensured that the programme is well structured and coherent.

The team highlighted the importance of considering the practical implications for ensuring staff and patients’ safety, such as working out the right timing/venue for the group and that the nurse running it wasn’t vulnerable as a lone worker.

The weight management group continues to be a good support network for people with a role in reducing loneliness and isolation in the Dale. The groups continue to be well attended by family groups with currently a married couple, neighbours and mothers and daughters regularly attending.

Watch this film about Improving outcomes in weight loss

Hear how practice nurses at the Old Forge Surgery identified unwarranted variation in their weight management consultations.

For more information contact

Sally Baker

Practice Nurse

sally.baker4@nhs.net