6713 Multi-professional working and service adaptation to improve service provision in a tier 3 weight management service for children living with severe obesity

Objectives Background The Complications of Excessive Weight (CEW) service is an NHS England-funded pilot for under-18s with severe obesity and related complications. Nottingham University Hospitals and University Hospitals Leicester NHS Trusts form the East Midlands hub. The service was initially commissioned to see 50 patients per site per year. Alongside sharing of guidelines, pathways, education resources and joint monthly team meetings, the sites shared physiotherapy, admin, psychology and nursing posts but had separate medical cover, social workers and family support workers. Later, a 35% increase in funding accompanied a doubling of patients and from a wider geographical area. We review the MDT evolution to increase capacity and better meet demand. Methods In order to facilitate expansion and improve the efficiency ( cost per patient), staffing models and funding allocation were adapted flexibly, novel approaches to patient engagement models of working were utilised. Results Staffing & funding Separating the allocated funding to Nottingham and Leicester improved recruitment processes. Nursing time was increased with a nurse at each site. Fixed-term roles were arranged to trial innovative MDT models e.g. exercise physiologist and assistant psychologist. Hours were increased for roles where need was particularly identified. Unused funding was proactively identified and used to employ a youth worker and clinical fellow. Capacity Increasing patient appointments was key. Allied health professional appointments were offered alongside MDT appointments, targeted to patient need. We maximised available clinic rooms by running adhoc clinics and filling cancellations at short notice with patients able to attend these. Home visit numbers increased by upskilling existing staff. Community venues, close to patients, were used to run cooking sessions and to offer family focused – non-violent resistance (NVR) training. Improving patient engagement High 'was not brought' rates reduced available slots. Families were contacted ahead of clinic and offered the travel compensation scheme to reduce the financial cost of attendance if they met criteria. Clinics were overfilled to allow for non-attendance. Pre-clinic telephone contact helped to identify any family or patient issues, such as access or language barriers so that appropriate adaptations could be made. Model of working Both virtual and in-person options to improve patient engagement are offered. We have adopted a 'hub and spoke' method of working to allow care closer to home, reducing travel time and missed education. Conclusion By working in a responsive and adaptable manner the service met the increased targets while maintaining quality and intensity of care.