How can referrals of patients who are obese to the local exercise referral scheme be increased? A UK based primary care quality improvement study.

Abstract

Background: Obesity is classified as a body mass index (BMI) >30kg/m 2 and contributes to poor health outcomes in the UK. In 2017-18, obesity resulted in 711,000 hospital admissions. The National Institute for Health and Care Excellence (NICE) recommends GPs educate patients who are obese and refer them to exercise programmes. Our practice, Brierley Park Medical Centre, (NHS Mansfield and Ashfield CCG) is in a 4 th decile most deprived region of North Nottinghamshire (UK) and serves a population of 9,288. The local exercise referral scheme (ERS) allows clinicians to refer patients to the local gym for a reduced fee at the point of access. Aim: To calculate and increase the number of adult patients who are obese in our practice who are referred to the local ERS. Method: The number of adult obese patients who were referred to the local ERS scheme from October 2018 to September 2019 was calculated. An intervention comprising internal system alerts, GP education utilising Making Every Contact Count framework and targeted patient group text alerts was designed and delivered. Pre (cycle 1) and post (cycle 2) intervention data from November to February were generated and compared. Results: In total, 2766 adult obese patients (29.8% of practice population) were identified: 16 (0.2%) patients were referred to ERS during cycle 1.96 (1%) patients were referred during cycle 2. Conclusion: The interventions that we have designed and implemented have increased the number of referrals to ERS and may be applied to similar primary care settings.