Access to adult weight management in primary care: qualitative interviews with key stakeholders from NHS weight management services in Scotland

The problem

Obesity is one of the biggest public health problems in the UK today. Recent policy has suggested that more can be done in primary care to support adults with obesity to maintain or lose weight. In particular, GPs and practice nurses could improve the identification and referral of adults with obesity to appropriate weight management services. Previous qualitative research with primary care practitioners has highlighted a number of barriers to this, including lack of time, lack of confidence in discussing weight, and perceptions of poor outcomes of interventions. However, the views of those involved in organising and implementing weight management services has not received so much attention. This qualitative study aims to address this gap.

The approach

Stakeholder interviews were conducted as part of a realist synthesis of interventions targeted at primary care practitioners to improve the management of co-morbid obesity [PROSPERO register of systematic reviews, CRD42014009391].Key stakeholders involved in the organisation, planning and delivery of adult weight management services, were identified and invited by email to take part in the study. Semi-structured interviews with a total of nine stakeholders, representing seven of the eight largest NHS Boards in Scotland (Approximately 80% of Scottish population) were audio-recorded and transcribed verbatim. Topic guides were used to explore views on engagement with primary care practitioners and barriers to accessing weight management services. Transcripts were coded using NVIVO software, analysed thematically using the ‘one sheet of paper' (OSOP) approach and discussed within the team.

Findings

There was considerable variation in the availability, organisation and funding of weight management services across the different Health Board areas, as well as different referral processes for accessing the services. Many services had undergone, or were undergoing, significant re-structuring, largely in response to Scottish Government targets for bariatric surgery.Most stakeholders had negative experiences of engagement with primary care practitioners around weight management (e.g. general lack of interest, or failed pilot projects) and offered several possible reasons for this (e.g. lack of ring-fenced resources, inadequate training, poor awareness of limited available services). They had a number of suggestions for improving access to weight management services, including: more secure, longer-term funding streams; more consistent, standardised services; better communication with GPs and practice nurses; ongoing service evaluation and feedback to GPs. These findings helped to inform the realist synthesis.

Consequences

A key component of addressing the public health challenge of obesity is improving access to weight management services. There are several barriers to the identification and referral of adults with obesity by primary care practitioners, including practitioner factors (e.g. time, training) and service factors (e.g. access, availability, engagement with primary care). Adequate resourcing and a more consistent approach are necessary precursors to improving standards in this area.

Credits

• David Blane, Public Health, University of Glasgow, Glasgow, UK
• Sara Macdonald, Public Health, University of Glasgow, Glasgow, UK
• David Morrison
• Kate O'Donnell, Public Health, University of Glasgow, Glasgow, UK