HEALTH SELECT COMMITTEE INQUIRY INTO OBESITY  18.12.03

  We would like to thank you for the opportunity to contribute evidence on the 18.12 03. We are aware that there was limited time at the session and felt that a brief letter of our considered thoughts after the oral evidence session may help to give clarity to the points we feel are pertinent to the issue of obesity and weight management in primary care.

  Patients requiring weight management need to be able to access relevant, sustainable support, which fits with daily living. Primary care can act both as a provider of care and as a gateway to a menu of approaches to match the needs of different individuals. This could include structured one to one advice provided by a health professionals or group support provided in primary care moving on to prescription of anti obesity medication, dietetic referral and if appropriate attendance at a specialist clinic. It must include access to a variety of physical activity opportunities, and where appropriate other interventions such as behavioural therapy, cooking classes, or attending commercial slimming groups.

  The option to refer for comprehensive surgical intervention is also needed and must be appropriately commissioned by PCTs. This should however be the end point of a systematic stepped approach, which includes the menu of weight management strategies above. This means having a primary care based weight management service which has access to specialist services provided in both primary and secondary care.

  Much was made of the role of NSFs at the hearing. Obesity is not an explicit target in the CHD NSF but is addressed within `lifestyle interventions'. It is good practice for PCTs to have some evidence of addressing the problem, however, it is unlikely that any real commitment to tackling obesity can be made until it is made a priority, backed with year on year funding. As suggested in the session the inclusion of obesity within a chronic disease NSF would go some way to achieving this.

  Equal priority needs to be given to content of the new GMS contract, which currently includes Quality Indicators for the recording of BMI only for patients with diabetes. This is a first step in the systematic approach, which must be widened to encompass all at risk groups for example those with established CHD and then movement towards a population approach. There needs to be a process in place after individuals are identified as obese with Quality Indicators and payment to support the activity attached. This is another possible way to prioritise obesity management within primary care.

  With regard to the development of new professional roles for obesity management, we feel better use of existing roles is more appropriate with a broadening of involvement from other stakeholders. This would involve developing the skills of health professionals and other health care workers, as well as employees of partner organisations such as leisure and community groups. Training to develop knowledge and skills around weight management, including clarity on effectiveness of intervention, along with a systematic menu based approach via the use of care pathways and guidelines and good quality resources to support both patients and professionals is essential.

  Dieticians are in short supply, skills can be best utilised as advisors, trainers and facilitators. Dieticians could also have a role in leadership on obesity. Leadership is needed at a national, regional and local level, this is necessary to contribute to sustainability and ownership within organisations.

  In conclusion, there are several barriers to role out of a systematic menu based weight management approach in the current NHS climate for several reasons:

  —  Lack of priority currently within the NHS.

  —  Needs increase capability and capacity of staff.

  —  Priories of partner agencies does not currently allow effective joint working.

  —  Needs leadership nationally, regionally and locally.

  —  Needs organisational ownership.