We must go beyond the 'fat register' in the QOF
Instead of our profession chasing our tails and treating the consequences of obesity, we should start to treat one of the known and obvious causes, writes Dr Matt Capehorn.
Harm from obesity may already be worse that that from smoking, and prevention has certainly failed. Treatment should now become the priority and GPs must provide more direct help to our patients, as we do when we refer smokers to structured cessation clinics.
The National Obesity Forum (NOF) is urging the Government to tackle this head on, and in particular to address the irony of the Quality Outcomes Framework (QOF), which rewards GPs for recording the numbers of obese patients – but not for doing anything about it. Although this information is useful, merely drawing up a register will not prevent a single overweight person from developing type-2 diabetes or a single obese person from having a heart attack.
NOF began a campaign in June 2012 to reform the way in which GPs are paid. QOF needs reform in order to reward those GPs who steer their overweight and obese patients into structured weight management programmes that help them to lose weight in a safe way and with the necessary support and advice to help them maintain this weight loss.
What is needed are QOF indicators for the identification of obese patients (similar to the eight points that currently exist for having an obesity register). But we also need further indicators for the appropriate screening of these ‘at risk’ patients for the other common associated co-morbidities (such as diabetes, dyslipidaemia and obstructive sleep apnoea) plus additional indicators for ensuring that appropriate weight management advice has been given and that a referral has been offered.
In an ideal world we would have enough time to deal with all of the problems that our patients have on every occasion, but we rely on the QOF to help us identify priorities.
The NOF agrees with the BMA and our medical colleagues that a GP’s pay should never be determined by the weight of their patients, or their success in a weight management clinic, but that GPs should be incentivised to refer obese patients into structured weight management programmes, similar to the successful smoking cessation programme.
This can be achieved very easily with QOF points for appropriate screening and referral of such patients. It may also drive up the number and quality of weight management services. A Government White Paper already insists that each PCT must have an obesity strategy, but it lacks specifics – if we incentivised more referrals then over time we would end up with more programmes, and more effective ones.
See what we’re doing
At present there is a huge geographical variation in the quality of weight management services. The obesity strategy in some areas may just be to rely on GPs referring patients to practice- or secondary care-based dietitians.
In other areas, such as Rotherham (where I work), there are services that include comprehensive specialist multi-disciplinary teams, and facilities for weight management. Over time having more weight management programmes across the country will add to the existing evidence base and allow us to see what works best for patients.
It is reassuring that MPs are finally beginning to grasp the scale of Britain’s obesity epidemic, and its central role in the range of potentially fatal and highly expensive ailments. However, some may still need to get out and spend some time in our surgeries to appreciate the problem. My invitation goes out to them to spend a day at the Rotherham Institute for Obesity.
After all, it is urgent that we start to deal with obesity more effectively. Currently one in four adults is clinically obese, and this is predicted to rise to one in two by 2050.
Direct and indirect costs of obesity may reach a staggering £50bn a year, or more by then, which we are told will bankrupt the NHS. The latest National Child Measurement Programme figures show that the numbers of overweight and obese children in Year 6 (aged 10-11) is still increasing, and this will be adding to the future burden on the NHS.
The Government wants us to tackle diabetes and other long-term conditions, as well as reduce admission etc, and we need to appreciate that obesity causes or worsens nearly all of these long-term problems. Instead of our profession chasing our tails and treating the consequences of obesity, we should start to treat one of the known and obvious causes: the weight of the nation.
The latest Health Survey for England data (2011) and shows obesity prevalence is 24% in men and 26% in women.
The percentages that are overweight or obese are 65% men and 59% women.
Source: HSE, 20 Dec 2012
Dr Matthew Capehorn is a GP in Rotherham and clinical director of the National Obesity Forum