From ASA research and ASA staff it has been identified that GP referrals are happening across England.

Transcription

1 Introduction A GP referral is a direct referral from a GP to a patient, prescribing them to take part in an exercise programme. A patient is identified as having a certain illness, ailment, or disease that needs treating, in this case by a form of exercise. The GP writes the patient a letter explaining what the problem is, and the patient then takes that to their local leisure centre so that the centre staff know what their health problems are, and what forms of exercise they should be doing in their centre. There is also another strand to this; GP recommendation. This is where the patient is at risk of developing a certain illness, ailment or disease, so they are referred to exercise as a preventative measure. From ASA research and ASA staff it has been identified that GP referrals are happening across England. There are many schemes running throughout the country regarding GP referrals and recommendation. Some centres offer a set amount of sessions over a certain period of time, including assessments throughout. They can work in partnership with the NHS, or can be lead by providers, or the programmes can work with local community groups or in silo. There is not a standardised way in which referral and recommendation seems to be happening. Fitness or health professionals within centres need to be qualified to design fitness programmes for people with health issues and can have a range of qualifications. For certain health issues exercise needs to be supervised, this will be taken into account when assessing if a CPD is required, as it does not already exist for a swimming teacher. It is not yet clear whether health referrals are a priority for GP s, or if it is happening sporadically, it would be ideal if exercise referrals were a primary tool for health improvement for at risk groups instead of a course of prescription drugs. Aim To increase the number of people swimming through GP referral/recommendation and increase the opportunity to sign post patients towards swimming as their sole form of exercise, or a way of complementing other things that they are doing Assess what the barriers might be to GP referrals, what the barriers might be for people to access physical activity (in particular swimming), and what motivates them Assess what is going on in the country and what is working Explore if this is a feasible tool for GP s to widely use, if it will save their time and money and how they can form relationships with leisure centres Use this as a piece of research to back up the belief that swimming is beneficial to health and can save GP s time and money by prescribing it 1

2 Method Exploratory and evaluative research to highlight individual cases of good practice Information will be gathered by liaising with and looking at; ASA Health and Participation team Contacts that the ASA H&P team may have (Swim Active co-ordinator) Health professionals Regional Directors Aquatic Officers Pool managers Pool centre staff Gym and swim instructors Local authority websites GP referral information online Questions and points to consider (Swim Active project co-ordinator) How can the ASA work with the NHS and leisure centres to help entice these people into the pool? In isolation GP Referrals won t happen how can we establish a relationship? Challenging to try and get health professionals involved what will get them engaged? It is also difficult to engage with GP s what will get them involved? Community health professionals are helpful how can we increase their impact? Health trainers and champions are a more productive route how can we maintain these roles? 2

3 Research- information/ facts and what is already happening Findings- Examples of existing schemes Swimfit This is an example whereby Swimfit is utilised as a GP referral project for swimming. Participants are referred from their doctor s surgeries or health professionals based on their medical condition, and then prescribed to take part in effective, fun and social activity for 6 months, to improve their health and wellbeing. The scheme started by running at 3 pools across the county back in 2009, and in 2010 was supported by the Governments Free Swimming project allowing the scheme to expand. The sessions have since expanded to running at five sites across the county-with more than 180 people taking part in the project, making a real difference to improving people s health and well-being through swimming. The current GP-referral, obesity swim programme provides participants the opportunity to go swimming as part of a get fit and weight loss programme. The new programme will take this one step further by providing specially designed swim classes aimed at maximising the effectiveness of the participant s time in the pool. Strengths are: Very popular scheme Free Social activity Specially designed classes make the patient feel that this activity has been tailored for them so is more likely to attend Weaknesses: Can t usually offer something for free, maybe discounted though? Is there the instructor, or the pool time to offer specialist sessions? 3

4 An example of Sports & Community Development Officer encourage GP Referrals Evidence of a new programme which was designed to help overweight people with their overall fitness levels and to lose weight in the privacy of a closed group session There are no specific GP referral swimming classes, if swimming is something that has been identified as an activity that the patient wants to do, the officer evaluates whether it is suitable or not There are, however GP referral aqua classes The classes ran for 12 weeks at a cost of 1.20 Class was open to all obese GP referral patients An example of how a GP Referral at a Leisure Centre works There is a referral service, but not directly between GP and the Leisure Centre anymore (it used to be about 7 or 8 years ago when it first started, but it runs itself now, so effort to maintain a direct link between LC and GP is not needed) GP refers the patient to take part in exercise the GP gives the pool programme to the patient and tells them where the leisure centre is and what sessions are most appropriate for them Patient then goes to the LC and signs up as a normal casual / membership user. The Leisure Centre initiated it - being proactive. This session is ONLY open to GP referred patients and they must turn up with a doctor s recommendation note. The sessions are lead by the gym instructors at the gym. They have a Wright foundation qualification (and a STA swimming qualification). In other words they are well informed and qualified instructors for swim and gym. They run a 1hr gym session, followed by a 30min swim They offer this 4 times a week, during the day to suit the aging retired demographic. 70% do one or the other (i.e. 1 hr of gym, or 30 min swim) 30% take part in the full 1.5hr session Public liability insurance covers the instructors Generally, there are approximately 6 new referrals a month. They currently have 50 active referrals at the LC. Around (70%) of these referrals convert to a membership at the Leisure Centre. However they don t track how often they use the LC but it s at least proof that they are investing in an active lifestyle. Some people even go back to the doctors to get re-referred since they love attending the gym that much. It is the social element that they enjoy. 4

5 The pool is dual use and runs at a private school, therefore membership size of the Leisure Centre is limited, and opening times are limited. They only have full-time staff, and so with fewer people involved, there is a friendly, personal service at the pool. High rapport established with clients How can the ASA help? Keen to initiate an Aqua GP referral qualification. They want new aerobic-type ways of helping people that don t just focus on raising the heart rate. One example is where they use a hydro-active 1,2,3 system they offer a GP referral service that people can progress along as they get fitter. The instructors want more information on how to better combine dry and wet side activities. They want the qualification to be a bolt-on CPD NOT an expensive week-long course. The instructors want more info on how to do a GP referral assessment in week 1 (like you would do in the gym). They already have something basic in place. Health Referral Scheme Example A District Council working in partnership with a County NHS and a Parish Council to provide a Health Referral Programme The Health Referral scheme aims to increase exercise and activity in everyday life for people who want to improve their health. It is designed for those people who currently do either no, or very little, physical activity but are motivated to do more. Being active each day makes us feel good, boost our confidence and improves health and wellbeing. A health professional can refer a patient to their nearest Health Referral Scheme. Firstly an appointment is made with their GP who will decide the patient can be referred to Health Referral programme. (Practice nurses, weight management advisors, stop smoking advisors, community mental health staff, hospital staff can also refer Health Referrals). 5

6 Who can join a Health Referral programme? Adults (16 years and over) who: Take part in little or no exercise. Are willing and motivated to become more active to benefit their health in the long term. Are living with health conditions which exercise would help: - weight loss, heart problems, high blood pressure, diabetes, mobility problems (joint, muscle pain) or you live with a level of mental ill-health. The Health Referral administration team will contact the patient to invite them to a 1:1 appointment to talk about the referral and plan an exercise programme that is best for them Activities can include: - Gym - Zumba - Swimming (Swimfit) - Pilates - Aquacise - chair based exercise - Group exercises - Walking for Health -Jogging- low impact circuit training - Cardiac rehabilitation The scheme is for 12 weeks. Progress and goals will be assessed after this period and a personal ongoing exercise regime will be planned to suit requirements to maintain a new active lifestyle Health Referral is offered at a significantly discounted rate to support all, including the vulnerable and disadvantaged ( ). Points to consider; Patient needs to be motivated to do exercise Personal 1:1 will make the patient feel like someone is investing in them Swim fit and aquacise classes add a social element Personal, ongoing exercise regime allows progress to be tracked and the patient to tailor their exercise programme to suit them 6

7 Pool visit visited a Leisure Centre in Bolton to discuss a Be a Better Swimmer evaluation and it became apparent a group of cardiac referral patients were taking part in the session. They had initially been referred to exercise classes in the gym and all decided to go along together and start swimming. Promotion They either had a text message about them, as they had attended lessons already in the past, or were referred by the Cardiac Rehab programme that they were on. Motivations The cardiac rehab programme is a multi-sport fitness programme that is supervised by trained cardiac professionals. Swimming is an option, as is gym sessions/circuits etc. One swimmer said she had lost her confidence in the water and needed her memory jogging on how to do it; she would never have taken part in the swimming if it wasn t for the offer of hints and tips. Barriers It would be good if the Cardiac professionals were trained to give swimming hints and tips, as would it be good if the teachers were trained in cardiac rehab supervision Structure The focus group participants said that they liked having the structure of a formal lesson because: They like the motivation factor attending actual lessons is a reason to bother going swimming They like meeting new people the social aspect of it and the accompanying support structure that comes with it. They like the luxury of space in the pool. They would rather pay extra to guarantee a comfortable, spacious swim 7

8 Conclusions GP referrals and recommendations are occurring and in some cases, swimming is heavily promoted, but not always There is no standardised way that GP referrals occur- but, is this a problem? Further research is required A social element may give people the extra push to get in the pool- consider aqua classes, Swimfit sessions and referral swimming classes CPD for swimming instructors/coaches similar to the gym qualification is needed, and this idea has been warmly received Will improve people s health if they exercise or swim more. May particularly work and act as a solution for people dealing with their weight and obesity issues Barriers to participation: self consciousness, and lack of motivation. Specific referral classes full of people in the same position may ease these worries. A meet and greet session as well as a personal 1:1 consultation may also make getting in the pool easier Suggestions Match certain health concerns and problems to swimming - what can swimming help with the most? Heavily promote the benefits of swimming to GP s and the health service Educate centre staff with the benefits of swimming Direct people from the gym into the pool (potentially as a group) Do not just suggest straight forward swimming- think about ALL aquatic activities Make sure more centre staff are qualified in prescribing and monitoring health referral patients and devise an aquatic qualification that allows them to do this (CPD Bolt-on qualification) Need to look far more closely at this- follow certain people, and conduct focus groups with referral patients Link with Be a Better Swimmer and Slimming World Link with community health projects From links not only with GP s but other health professionals Is swimming even sold as an option? Or is it just the gym? It takes 3-12 months to make something a habit, therefore GP referral programmes would need to be longer than 3 month to make sure people carry on swimming and exercising, and that swimming is not just seen as a quick fix 8