Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND3.52 We found that very few general practitioners used theprotocols proposed in either of these guidelines. Indeed,only four per cent of general practitioners used aprotocol for managing overweight or obese patients,and many of those in use had been developedindependently by the practice.3.53 We assessed the potential usefulness of 35 protocolsprovided by practices against four criteria developed inconsultation with members of our expert panel. Weexamined whether the protocol:nnnnhad a clearly expressed aim or objective;defined which patients to target for advice ortreatment;identified clear treatment and referral criteria;had a timetable and instructions for review andfollow-up.3.54 Three of the 35 protocols satisfied all the criteria, and afurther 16 satisfied at least two. The majority had notimetable or instructions for review and follow-up, andhalf did not have clear treatment and referral criteria.Improvement and standardisation of protocols bybuilding on best practice offers the scope to producebetter outcomes for obese patients.3.55 From our survey of health authorities, we found twoexamples of guidance for primary care teams on whento refer overweight and obese patients to a dietitian, oneof which had been developed by a health authority(West Sussex Health Authority), the other by an NHScommunity trust (North Mersey Community NHS Trust).Such guidance informs local general practitioners aboutthe service offered, to ensure consistent management ofpatients, and to make the best use of dietetic resourcesprovided in the local community.3.56 Our analysis indicates that, even where some form ofprotocol was in use, it rarely constituted acomprehensive framework for the management of obesepatients and those at risk of obesity. And none of theprotocols in use had been independently evaluated toestablish its effectiveness. In the absence of suchinformation, general practitioners and practice nursesdo not have clearly defined criteria for the managementand treatment of overweight and obese patients, andthere is no guarantee that patients, even within the samesurgery, will obtain consistent and effective treatment.part three28There is a clear view as to what guidance shouldcover3.57 We asked the general practitioners and practice nurseswe interviewed what they would like to see included ina national protocol or guidelines on obesity, if one weredeveloped. All said that they would like guidance whichcovered the topics set out in Figure 16.