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The National Health Service (NHS) in England is piloting an extension of access to its Digital Weight Management Programme, a digital service to support behavioural and lifestyle changes for weight loss. Access is being piloted to include referrals for patients with a body mass index above a threshold level set by NHS England and who either have a diagnosis of osteoarthritis of the knee or hip (musculoskeletal referrals – 11 pilot sites) or are on elective surgical care waiting lists (elective care referrals – 10 pilot sites). There is marked variation across sites in the number of patients referred.
However, the number of patients referred to Digital Weight Management Programme from each pilot site varies significantly. The purpose of this evaluation is to understand reasons for variation (local implementation, barriers, facilitators) and experiences of the implementation and functioning of referral pathways for musculoskeletal and elective surgical care patients into the NHS Digital Weight Management Programme.
RAND Europe researchers, along with our University of Birmingham partners in the NIHR-funded BRACE Rapid Evaluation Centre, are evaluating the referral pathways at seven pilot sites (three musculoskeletal, and four elective surgical) to identify how referral processes have been implemented in different sites, what the barriers and facilitators to implementation and reach were, and the acceptability and experiences of different patient groups and healthcare practitioners.
The first stage of the evaluation involved analysing all the pilots’ referral data to identify suitable sites for further investigation. This was accompanied by scoping interviews with key informants (n=18) and a rapid scan of the literature to inform evaluation design. The second stage of the evaluation focused on interviews at our seven case study sites, with both professionals involved in the referral process (n=25), and with patients (n=18) who were eligible for a referral. The third stage involved online workshops with representatives from all of the pilot sites, not just the case study sites, to clarify and validate findings.
Sites that created referral processes that optimised clinical staff time (e.g. automation, use of administrative staff) and involved ways to capture BMI if missing from patient records were more likely to have a higher number of referrals. Despite generally positive attitudes towards the Programme, many staff felt they had insufficient information to describe it accurately to patients, which may impact both offering and acceptance of referrals. Strong leadership and personal staff motivation also likely impact referral offers. Similarly, patients were more likely to accept a referral if it aligned with their attitudes towards weight management and was offered at a time where they felt they could engage with the programme.
There is considerable variation between case study sites in the details of how they have implemented new pathways for referring patients to the NHS Digital Weight Management Programme. These differences likely reflect varying local contexts. No single best model for the referral pathways has been identified.
It would be desirable to capture the experiences of patients from diverse ethnic backgrounds and from patients who declined referral. Larger, longitudinal and observational studies could help understand the specifics of referral conversations as well as the effectiveness and cost-effectiveness of these referral pathways against other pathways to the Programme to aid decision making and development of support materials for staff.
