Key Facts at a Glance• Aim to create a person-centred intervention for

patients with type 2 Diabetes requiring weight management

• Improved quality of service for patients and reduction in clinical variation

• Increased confidence amongst staff in raising weight management issues

• Potential for the project plan and learnings to be shared more widely within the Trust and NHS Scotland

NHS Greater Glasgow & Clyde (GGC), the University of Glasgow, AstraZeneca and Merck, Sharp & Dohme (MSD) have collaborated to raise the issue of weight management in primary care for patients with obesity and type 2 Diabetes. The goal is to ensure that appropriate patients receive appropriate treatment at the appropriate time, as per clinical guidelines. The project commenced in November 2015 and will undergo thorough review by NHS GGC to assess the success of the different approaches.

The ChallengeSeveral barriers are preventing patients from receiving appropriate treatment for co-existent obesity and type 2 Diabetes, including a lack of knowledge amongst both patients and clinicians about the importance of weight management and possible treatment.1

Scottish Intercollegiate Guideline Network (SIGN) guidance recommends that ‘obese adults with type 2 Diabetes should be offered individualised interventions to encourage weight loss (including lifestyle, pharmacological or surgical interventions) in order to improve metabolic control’.2

The collaborative ‘Small Talk, Big Difference’ obesity and Diabetes project is intended to ensure that all NHS GGC patients who are overweight or obese and have type 2 Diabetes are identified and receive an equal approach to treatment and care. The treatment and care pathway is initiated by primary care staff raising and explaining the issue of weight management in a non-judgemental manner, followed by referral to a weight management service and concurrent treatment for the patient’s Diabetes.

The Steps TakenOnline training package for primary care staffTraining for primary care staff, via an online learning package and face-to-face experiential training session supported by AstraZeneca and MSD, was developed to cover links between obesity and type 2 Diabetes and the evidence behind weight management, how to refer patients to local services, general guidance on the management of Diabetes in obesity and assistance in raising the issue with patients.

Weight management materialsA toolkit of materials to support GPs during weight management consultations was created by AstraZeneca and MSD in partnership with the NHS — including a weight management readiness ruler, referral guide, clinical action plan and patient discussion tool — helping them to raise the issue of weight and how to set weight management goals.

Patient informationAn information leaflet for patients setting out reasons why weight loss important in Diabetes, methods of weight loss, local services and what steps to take next.

Project pilotA pilot was implemented at five practices to evaluate the implementation of the above training materials and packages, before wider roll-out across NHS GGC.

What We Expect to AchievePatient BenefitsThe main project aim is to create a safe, effective and person -centred intervention for patients with type 2 Diabetes requiring weight management. This will be done by early identification of key issues relating to patients with type 2 Diabetes and their weight and making referral options available to all those eligible.

Increased Confidence Among StaffIt is anticipated that staff will feel more confident in raising the issue of weight management with their patients having received the right guidance to refer patients on to specialist services. This will be measured by results of a primary care staff survey and analysis of referral rates and patient uptake ratios.

Benefit to the TrustIt is expected that an increase in appropriate patient referrals by primary care will lead to an uptake of services by patients creating an improved pathway flow. It will also lead to increasing personalised treatment of type 2 Diabetes for patients with weight management issues which improve the quality of the service and reduce clinical variation.

Expanding ServiceAfter the success of the pilot and initial roll-out, with continued support from AstraZeneca and MSD, the project is currently being adopted by all practices across NHS GGC. Subject to further review of data and results by NHS GGC, there is the potential for the project plan and learnings to be shared more widely within NHS Scotland and other parts of the NHS.

1. Wilkie, R. A qualitative study exploring patients’ reasons for failure to opt in to a weight management programme (Master’s dissertation based at GCWMS). 2015.

2. SIGN 116 Management of Diabetes, A National Clinical Guideline. 2010. Updated November 2017.

AstraZeneca Collaboration with NHS Greater Glasgow & Clyde and Other Organisations

Veeva: GB-12357 | Date of preparation: April 2018

The ChallengeSeveral barriers are preventing patients from receiving appropriate treatment for co-existent obesity and type 2 Diabetes, including a lack of knowledge amongst both patients and clinicians about the importance of weight management and possible treatment.1

Scottish Intercollegiate Guideline Network (SIGN) guidance recommends that ‘obese adults with type 2 Diabetes should be offered individualised interventions to encourage weight loss (including lifestyle, pharmacological or surgical interventions) in order to improve metabolic control’.2

The collaborative ‘Small Talk, Big Difference’ obesity and Diabetes project is intended to ensure that all NHS GGC patients who are overweight or obese and have type 2 Diabetes are identified and receive an equal approach to treatment and care. The treatment and care pathway is initiated by primary care staff raising and explaining the issue of weight management in a non-judgemental manner, followed by referral to a weight management service and concurrent treatment for the patient’s Diabetes.

Veeva: GB-12357 | Date of preparation: April 2018

The Steps TakenOnline training package for primary care staffTraining for primary care staff, via an online learning package and face-to-face experiential training session supported by AstraZeneca and MSD, was developed to cover links between obesity and type 2 Diabetes and the evidence behind weight management, how to refer patients to local services, general guidance on the management of Diabetes in obesity and assistance in raising the issue with patients.

Weight management materialsA toolkit of materials to support GPs during weight management consultations was created by AstraZeneca and MSD in partnership with the NHS — including a weight management readiness ruler, referral guide, clinical action plan and patient discussion tool — helping them to raise the issue of weight and how to set weight management goals.

Patient informationAn information leaflet for patients setting out reasons why weight loss important in Diabetes, methods of weight loss, local services and what steps to take next.

Project pilotA pilot was implemented at five practices to evaluate the implementation of the above training materials and packages, before wider roll-out across NHS GGC.

What We Expect to AchievePatient BenefitsThe main project aim is to create a safe, effective and person -centred intervention for patients with type 2 Diabetes requiring weight management. This will be done by early identification of key issues relating to patients with type 2 Diabetes and their weight and making referral options available to all those eligible.

Increased Confidence Among StaffIt is anticipated that staff will feel more confident in raising the issue of weight management with their patients having received the right guidance to refer patients on to specialist services. This will be measured by results of a primary care staff survey and analysis of referral rates and patient uptake ratios.

Benefit to the TrustIt is expected that an increase in appropriate patient referrals by primary care will lead to an uptake of services by patients creating an improved pathway flow. It will also lead to increasing personalised treatment of type 2 Diabetes for patients with weight management issues which improve the quality of the service and reduce clinical variation.

Expanding ServiceAfter the success of the pilot and initial roll-out, with continued support from AstraZeneca and MSD, the project is currently being adopted by all practices across NHS GGC. Subject to further review of data and results by NHS GGC, there is the potential for the project plan and learnings to be shared more widely within NHS Scotland and other parts of the NHS.