Published Tue, 2010-05-25 11:32; updated 1 year ago.
Lighten Up uses a call centre to direct and manage the referral and support of people with a BMI over 30 to local weight management services.
GPs are the first point of contact, sending a letter to their patients inviting them to contact the call centre to find out about free access to seven different weight management programmes.
Lighten Up has been very successful in targeting deprived areas of South Birmingham and a large majority of those taking part in the programme have successfully lost five per cent of their starting weight and maintained that loss after 12 months.
Context and background
A review by South Birmingham PCT examined how it could tackle the risk to health caused by rising obesity.
In South Birmingham it is estimated that up to 73,000 adults have a BMI over 30 and the review found that only 0.04% of the obese population currently accessed community based weight management services.
One effect of this was that the specialist services were receiving a high number of inappropriate referrals at very high cost (a referral to a specialist service costs £1,200 per patient) and these patients had not previously accessed any community weight management service.
GP’s write to their patients with a BMI of over 30 (recorded in the last 15 months) to advise them that they can receive free vouchers to use local weight management programmes – commercial and NHS - the letter invites them to contact the Lighten Up call centre to find out about the range of services available.
The call centre is staffed by local people who provide practical information and signposting to local services – over 53 different sessions in South Birmingham.
People can receive 12 free vouchers for seven different evidence based commercial and public sector weight management programmes. Once the patients has chosen a service, the call centre:
- Makes and confirms the booking
- Contacts the patient by telephone to remind them about their first appointment
- Follows-up the patient after their first visit to see how they got on, offering the opportunity to change provider if necessary
- Liaises with the service provider to ensure attendance and weekly weights are recorded on the Lighten-Up client management system
- At 12 weeks clients are provided with a 12 months maintenance pack and an agreed follow-up schedule that can include for example referral to an exercise programme.
What works well?
The call centre staff do not offer any opinions or undertake any motivational interviewing – they listen, offer positive reinforcement, encouragement and pass on factual information and signposting - this has been found to be successful in Stop Smoking programmes.
It seems that people like this practical and non-judgemental approach – anecdotal evidence has suggested that the anonymity of the phone may also contribute - the final evaluation may provide more information about this.
People report that they like being offered a choice of services and this was a key factor identified in the consultation undertaken as part of the obesity summit – people wanted to be able to choose which service they used.
Invitation letters sent from a patients GP work better than letters sent from the service. The pilot project in two GP practices helped to get the wording right to describe the project.
The maintenance pack has proved very popular; this consists of a voucher for a free set of digital scales (redeemed at Lloyds chemists), a weight record card, a hints and tips leaflet and follow up phone calls at 3, 6, 9 and 12 months.
Lighten Up is successfully targeting areas of deprivation – 83% of patients taking part in Lighten Up live in PCT deprivation quintiles 1 and 2 - the most deprived areas of South Birmingham where cost of attending a programme is highly likely to prevent people joining a weight management service.
In common with many weight management services more women than men use the service however between 16 and 20% of men are using some of the weight management services which is much higher than before Lighten Up began.
There was better male representation at Rosemary Conley classes, possibly due to the exercise element which has led us to look at the possibility of single gender groups and building in more exercise.
Sometimes people attended one session and then wished to change to another service – initially this was allowed but meant that two sets of 12 week vouchers had to be provided.
To overcome this, the providers were asked if they could provide a taster session before people made a choice but two providers refused.
The solution has been that people are now asked to sit in on a session they are interested in before making a final choice.
Contracts with weight management services need to be very specific, there have been difficulties with some providers around issues such as management of data; some providers have been more flexible than others.
Outcomes and impact
In the first 18 months of the Lighten Up service:
- 5,240 patients (average BMI of 34) have accessed the service
- The average weight loss at 3 months is 5.6% of body weight (n=4,837)
- Initial results show that 5.1% is maintained at 12 months
- The call centre remains in contact with over 75% of patients
- The call centre links to other lifestyle services such as Health Trainers and Stop Smoking services.
The final evaluation report carried out by the University of Birmingham is due in September 2010 and will report on the effectiveness of the individual interventions - i.e. commercial vs. NHS - and, the effect the call centre and patient choice had on increasing patient compliance and participation.
Other knock on effects that have been noted have included:
- Inappropriate referrals to specialist weight management services for patients with a BMI between 30 and 40 have reduced by 45% to 140 per year.
- Prescribing for weight management has slowed compared against national trends, showing that local GPs are offering referral to Lighten Up first before pharmacological treatment.
Lighten up is funded by South Birmingham PCT and the cost per patient per year is £68.
Staffing and resources
The call centre is staffed by two staff trained in the call centre management system and customer relations but not in nutrition or weight management. Lighten up is managed by a Project Manager and overall management is by NHS South Birmingham.