Susan Cohen shares how she helped encourage her patients to eat well, move more and improve their lifestyles.
People are living longer, the population is growing and waiting times are increasing and most NHS care is provided by the general practice. To meet these changing needs, the NHS must adapt to support patients and staff.
Patients frequently express a desire to lose weight and become healthier – but often have not been able to achieve this aim. This might be due to a lack of knowledge about how to improve health, a lack of motivation to take the necessary steps or a mix of these factors. After all, seemingly contradictory information is churned out daily around diet and lifestyle, which can be confusing to the public.
Our local population in Manchester is growing yet life expectancy has reduced in some areas. Over the years, it became apparent that the factors I mentioned above are prevalent among my patients. I felt it was incumbent upon us to be proactive and re-educate patients to improve their quality of life and life expectancy, for their benefit and for the long-term benefit of the surgery.
To address these points and increase our Quality and Outcomes Framework (QOF) points, our practice has been exploring the benefits of group consultations, but it has been hard work encouraging a large number of patients to attend.
I introduced a free six-week programme targeted at those who had been diagnosed with type 2 diabetes, hypertension or who had a BMI of 30 or above. Though the programme was originally called ‘Diabetic Review Session’, I updated the name to ‘Eat Well, Move More’ to make it more appealing.
The participants in our weekly programme lost an average of 4kg. But perhaps more importantly, they reported a greater sense of support, empowerment and optimism around making optimum lifestyle choices for themselves and their families.
Why did we do it?
The aims of the ‘Eat Well, Move More’ programme based on the General Practice Five Year Forward View were:
· Utilise active signposting by linking with Be Well Groups, which is a local support service in Manchester.
· Develop the general practice team by working alongside receptionists, management and clinical staff to run and support each session.
· Reduce non-attendance by using the sessions to attract patients to more informal drop-in appointments for follow-ups.
· Increase productivity with fewer members of staff supporting more patients.
· Social support, weight reduction, mental health support and housing to use social prescribing by collaborating with the Be Well Group and encouraging a member of their team to come for each session.
· Develop quality improvement initiatives by bringing people together for positive sessions that empower them to take steps to improve their own health, leading to greater satisfaction level.
Our programme came with many benefits for patients, which could be seen in weight loss and reduction in social isolation. Patients became more confident in asking questions and participating in the programme. One mum even bought a table so that her family of five could sit and eat together on a daily basis.
Practice staff benefited too. We wanted to retain more nurses at our practice by empowering them to plan, be creative, lead sessions and think outside the box to involve groups of patients and members of the practice. Likewise, the programme helped to develop career pathways for healthcare support workers, apprentices and nursing associates and improve their transferable skills.
There was an increase in surgery team building overall with staff developing new skills such as presenting and working with other team members. The focus and understanding of QOF points meant there was an increased enthusiasm to encourage patients to make appointments for annual long term condition reviews and assessments at the surgery.
The programme had a positive effect on patients and staff in that it promoted a healthier lifestyle for all and a greater community spirit.
How did we do it?
Consideration was given to:
· Room availability
· Educative evidence material around the subject that was to be discussed
· Personnel to lead and back up the programme
· Flip charts, pens, drink and food
· Time for planning, preparation, implementation and evaluation
· Time to search and identify patient groups and text patients
· Forward planning for further evaluation and future planning
The programme covered an array of issues from easy ways to eat healthily, how to accurately understand food labels, assess the contents of their fridge or review a photo of the previous day’s meal. I focused on the impact of alcohol and medication on lifestyle and weight loss, as well as health prevention and promotion using up-to-date evidence-based information. We also wanted to reduce loneliness by creating social contact hopefully resulting in new friendships.
Thinking about the psychology of New Year’s resolutions and so on, we contacted targeted patients to invite them to book onto the session in January by sending a one-off text message to patients who suffered with diabetes, hypertension or obesity.
Out of the 60 patients booked into the first session, 55 attended. In the following sessions, between 30 and 35 attended.
Each session was facilitated by a practice nurse and supported by a healthcare worker with other allied staff as appropriate, alongside support from the Be Well team. Sessions included:
· Weight measurements – so we had to make sure enough scales were available for patients to use
· A proforma for each patient to fill in medical and administrative data previously unaccounted for – which helped achieve QOF points and evaluate patient progress
· A short fun exercise with music to end the session
· Where applicable, appointments were made for outstanding medical reviews and tests such as immunisations, smears and asthma or diabetes reviews. For the first few weeks, a block of appointments was set up either side of the session to cater for this.
Each session had a flip chart with five points for discussion followed by a question and answer section. At the beginning of each session, we let the patients lead with questions in note form or verbally.
We brought a variety of food to look at, discuss and taste, the leftovers of which were raffled off at each session. Our health care assistant also prepared and handed out suggested healthy, interesting menus and practical snack recipes.
We encouraged the patients to bring their own food samples to the session to discuss issues such as portion sizes. It was amazing to see the different sizes of dinner plate used and how many patients were unaware of the breadth of healthy food, vegetables and spices available in regular shops. We endeavoured to educate them in a colourful and tempting way.
Socialising friendships were encouraged throughout: patients shared information, such as tips for success/weight loss, and confidence was gained in asking questions. However, it was important to keep to time and not overrun, as questions posed can always be answered the following week.
At the end of the programme, the evaluation forms that patients filled in were 95% positive. The concerns raised included what would happen next and whether the group would continue.
This type of 6-week programme can be rolled out in varied settings at any time of the year and a more personal, customised and lifestyle-based approach can be applied.
Helpful websites and groups for resources include:
· The Royal College of General practitioner’s Active Practice Charter
· Be Well in North Manchester, as well as Central and South
· Buzz in Manchester
· Healthy Hearts and Minds
· Health journals
· Weight assessment organisations
Susan Cohen is a practice nurse at West Gorton Medical Practice.