Increasing Referrals from Newham Borough to the East London Eating Disorder (ED) Service

 27th June 2024

By: Brian Sreenan (Consultant Psychological Lead) and Lucy Brewer (Senior Improvement Advisor)

The aim of this quality improvement project is to address the disparity in eating disorder referrals in East London. Notably, Newham, has particularly low referrals compared to Tower Hamlets and Hackney. Since starting this project, the team have seen a monthly average increase of 2.3 to 7.8 referrals from Newham. Furthermore, the proportion of referrals from Newham compared to other East London boroughs has also increased.

A big thanks to the QI ED Team: Selina Akhter (expert-by-experience), Mohammed Shahansha & Rhianna Dennis-Fennell (co-chairs), Sibgha Afzal, Isabelle Arnold, Elsie Obiageri, Colette West, Brian Sreenan, Rachel James (QI Coach)

Understanding the Problem

The team spent time understanding the problem by speaking to staff and service users and identified several factors contributing to this disparity. The contributing factors were hypothesised to be: A lack of knowledge about eating disorders (both mental health staff, GPs, residents) and a lack of awareness about services and resources available to support residents. From these discussions, they developed a driver diagram to illustrate their theory of change (Fig 1).

Fig 1: Driver diagram illustrating the drivers and change ideas developed for the project’s aim.

Change Ideas

The team have been testing the following ideas:

Self-Referral Form: A self-referral form was created, leading to increased referrals across three boroughs.

GP Training in Newham: Academic afternoons were organized to train general practitioners (GPs) in Newham on identifying and referring patients with eating disorders.

Leaflets and Guides: Informative leaflets and referral guides were distributed to GPs in Newham, providing clear instructions on how to refer patients.

MH Awareness Week at UEL: An awareness week at the University of East London (UEL) aimed to increase understanding of eating disorders among student populations.

Targeted Poster Campaign: Posters were placed in council-owned gyms to raise awareness and encourage referrals.

Outcome and Next Steps

Since starting this project, the service has seen an average monthly increase from 2.3 to 7.8 referrals from residents in Newham (Fig 2). They have also increased the proportion of referrals which come from Newham from 15% to 19% in comparison to City and Hackney and Tower Hamlets.

Fig 2: I chart demonstrating monthly number of referrals to the ED service from Newham.

The project team continue to test their change ideas and hope to further increase referrals over the next few months. One of their next change ideas is to build relationships with faith leaders, recognizing their influence in the community. Additionally, the team will be joining the next phase of the Quality Improvement Equity Program to look at reducing their “did not attend” (DNA) rates and improving patient outcomes.