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Call for tougher QOF obesity indicators

By Alisdair Stirling

A leading GP obesity expert is calling for the QOF to be substantially reshaped to focus on obesity after a major new study found GP interventions were ‘highly cost-effective’.

Dr David Haslam, chair of the National Obesity Forum, said the ‘absurd’ current obesity indicator in the QOF, for drawing up a register, should be replaced with targets for screening and offering lifestyle advice.

His comments came as an economic analysis of the pioneering Counterweight programme, for weight management of patients with type 2 diabetes, coronary heart disease and colon cancer, found it cost £60 per patient to deliver, but would save the far more.

The researchers, including leading academics from the University of York’s Centre for Health Economics, called for weight management programmes to be ‘routinely adopted’ in primary care.

Their evaluation, published in the International Journal of Clinical Practice, was based on a 12-month programme run in 65 GP practices with 1,419 patients who had a BMI of 25 kg/m2 or over.

Patients were counselled by ‘weight management advisers’ – practice nurses or other primary care workers.

Counterweight cost £59.83 per patient entered. Patients lost a mean of 3kg after 12 months and 2.3kg after 24 months – in both cases 4kg below the predicted 1kg/year background weight gain.

Even in a ‘worst case scenario’, where weight loss was entirely regained over the next two years, the programme cost only between £2,017 and £2,651 per quality-adjusted life-year.

‘Weight management in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare use could offset the total cost of providing the programme, as well as bringing multiple health benefits’, the study concluded.

Dr Haslam, a GP in Watton-at-Stone, Hertfordshire, and a board member of Counterweight, said: ‘The QOF needs to be amended to include targets for screening and offering weight-management advice. We try every year to have the target changed and government advisors have agreed the evidence is very robust. But something else always takes precedence.’

Dr Andrew Brewster, a GPSI in obesity and type 2 diabetes in Caversham, said the current QOF arrangements meant GPs were just measuring the obesity epidemic, but didn’t see new indicators as the solution: ‘We should have lots of different interventions for different people – market segmentation. Tick-boxing is not the way to go.’

Dr Paul Singer, a GP in Luton whose practice took part in Counterweight, said: ‘It was successful, but very labour-intensive. We’re still using some the Counterweight tools, but have had to modify them to save nursing time.’

Call for tougher QOF obesity indicators