Worcestershire Activity Referral Schemes

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1 Worcestershire Activity Referral Schemes County Protocol 1. Aims 1.1 To implement Government and local strategy for increasing levels of physical activity in higher risk groups. 1.2 To reduce the risk of developing chronic diseases and obesity and limit progression. 1.3 To improve mobility, mental health and well-being. 1.4 To motivate patients towards sustained changes in lifestyle and increased levels of physical activity. 1.5 To develop a sustainable Activity Referral Schemes system through a partnership involving the PCT, local GP s, Health Professionals and Worcester City Council s Safer and Stronger Communities Directorate. 2. Strategic context 2.1 The main policy drivers include: - the Public Health White Paper Choosing Health Choosing Activity, National Service Frameworks, the Regional Sport and Physical Activity Plan, Worcestershire Local Area Agreement and joint Local Development / Delivery Plans. 2.2 The scheme is being designed in line with:- - Guidance from the Department of Health s National Quality Assurance Framework for Exercise Referral Schemes (2001) - Recommendations from the Wright Foundation (consultants in Exercise Referral and specialist training providers at ) 3. Clinical and Legal Responsibilities 3.1 Clinical and Legal Responsibilities (pg. 12/13 NQAF) When the individual is specifically referred for exercise by the health practitioner, responsibility for safe and effective management, design and delivery of the exercise programme passes to the exercise and leisure professionals. Exercise professionals should be members of the Professional Register for Exercise and Fitness (England) which requires the possession of appropriate professional indemnity insurance (All local Exercise Professionals are qualified to advanced level 3 and are members of the National Register with their own indemnity) 1

2 3.2 An Integrated Care Pathway (pg. 13 NQAF) The DoH National Quality framework states: By making a referral to an appropriate person or dedicated facility where qualified exercise staff are available, the medical, nursing or therapy practitioner is not assuming responsibility for the administration or delivery of the exercise programme. When the individual is specifically referred for exercise by the health practitioner, responsibility for safe and effective management, design and delivery of the exercise programme passes to the exercise and leisure professionals The scheme will therefore be called a referral scheme. 3.3 Liability (pg.4 NQAF) Because liability issues may be a perceived concern of referring general practitioners, advice was sought from the Medical Protection society in March The introduction of the exercise professional who will be registered with a national body and have an indemnity in respect of his work is welcomed. We see no difficulty in GP s providing the exercise professional with details of the patient s past medical history with the consent of the patient and it will then be for the exercise professional to assess the suitability of the patient for a planned programme of exercise, the content of which would be his responsibility. It would be expected that the exercise professional would feed back to the GP any problems that are encountered and the progress that is made through the programme Medical Protection Society 29 March Referral Criteria The Activity Referral Scheme can accept referrals from General Practitioners, Practice Nurses, Specialist Nurses and Health Trainers and Primary Care Professionals, of adult patients with stable chronic medical conditions including:- Obesity / Weigh problems Stable Hypertension Stress Mild Depression Mild-moderate Arthritis Diabetes Osteoporosis Asthma Lower back pain Poor mobility 2

3 4.1 The following patients should not be referred to the programme, those who :- - Are already physically active on a regular basis - Have unstable angina - Have recently had a heart attack (please refer to specialist cardiac rehab team at the Worcestershire Royal Hospital) - Have uncontrolled high blood pressure 5 Proposed Method of Scheme Delivery The method of delivery for these schemes is described below. There will be post scheme support for participants with follow-up interviews or appointments at 6 months and 1 year. 5.1 The following section illustrates the basic requirements for the preferred scheme using the centralised group method - A weekly appropriate practical exercise session lasting between 30 and 45 minutes - A weekly opportunity for the participant to meet with the scheme coordinator and work in groups or individually to discuss weekly food logs and activity diaries - A weekly information session on local provision available for the participation to access after their involvement in the Referral Scheme 5.2 Below is a more detailed example of how a 12 week group scheme may be delivered. Week 1 Introductions of staff and participants Tour of the host facility Ice breaker to develop group dynamics and cohesion Introduction into scheme sessions Physical assessment of participants, measurements taken Food Log and Activity Diary distributed and discussed Week 2 12 minute controlled walking assessment Theory of application to participants daily routines Information on local walking provision Introduction to and distribution of pedometers Goals set using pedometers and Activity Diaries Week 3 Introduction to types of activity, including formal exercise and informal active recreation and physical activity in daily routines 3

4 Practical session of appropriate low-intensity exercise Week 4 Healthy Eating theory guest speaker Application to Food Logs Practical session of cardiovascular gym work Information on local gym provision, times, prices, peak hours, and home alternatives Week 5 Stress and Relaxation theory guest speaker Stretch and Flex/Yoga style session Information on local appropriate relaxation activity provision or resources for relaxation at home Week 6 Walking for Health guest speaker Practical health walk, lead by WHI walk leader Local information on health walks and walking groups in the local area linking in with Sports Partnership work Week 7 Review of progress so far Formal 1:1 with scheme s coordinator Reassess physical measurements Practical session on exercise to music or dance Application of dance to daily routines Weeks 8 & 9 Individual choice of activity in host centres Partners of the participants invited to meet staff and discuss ways in which they may offer help and support in daily routines and local provision Weeks 10 & 11 Speakers from local sports clubs and active recreation groups, supportive by the County Sports Partnership, give information on support and local provision Individual choice of activity in host centres Week 12 Individual choice of activity in host centres Group discussion on ways to maintain and develop levels of activity 4

5 1:1 planning for independent future formal and informal activity Final physical assessments and 12 minute walking test Signposting Directories distributed and local provision and facilities exhibited by the County Sports Partnership 5.3 Below is a more detailed description of how the Signposting Referral Method may work: - An initial consultation will take place with the programme coordinators where participant background and history will be discussed. - The participant will also discuss what outcome goals and preferred forms of activity they have. - They will then be signposted to subsidised classes, community based schemes or daily activities that are already part of an existing programme at the local authority in question. - The participants will be offered a 4 week, 8 week and exit (12/13 week) consultation in which nutrition and lifestyle advice will be offered. - A strong emphasis on sustainability will be maintained throughout by supporting and signposting participants to a comprehensive menu of Active Recreation options including access to leisure facilities, community based activities and generally functional activity information. - The signposting will be available online and in hardcopy, produced specifically for the Local Authority. - The documents will include comprehensive information on name of group, address of meeting place/group, contacts details, membership numbers, number of coaches and accreditation details if any. 6 Signposting Vision 6.1 Signposting Booklet - The Sports Partnership Herefordshire and Worcestershire will provide a signposting resource for distribution to participants. This resource will direct people to local, district level provision, detailing activities, contact details, venues, times and dates. 6.2 Internet Mapping exercise - The Sports Partnership Herefordshire and Worcestershire will be mapping all Active recreation and Physical Activity groups, clubs and societies across the sub-region including a Where can I be active? search 5

6 facility, which will detail parkland, open spaces, county parks and circular walks and cycle routes. 7 Governance and Accountability 7.1 Steering Group The schemes will be directed by a county structure divided into county level and district level task groups. The groups will report its progress to the Herefordshire and Worcestershire Physical Activity Partnership (PAP) and the local Community Sports Networks. The set-up of the steering group will be as follows: Richard Whincup Sports Partnership Herefordshire and Worcestershire. Susan Pinfold-Brown Worcestershire Primary Care Trust. Suzanne Gardner Sport England West Midlands/ Dept of Health Peter McKenzie-Shaw Worcester City Council. Chris Swanson Worcestershire Primary Care Trust (Health Trainer Service). District Scheme representatives 7.2 Task Groups The Local Task groups will be set-up as follows. Richard Whincup Sports Partnership Herefordshire and Worcestershire. Sports/Physical Activity Development Officer Local Authority. Health Improvement Co-ordinator Worcestershire PCT. Fitness Instructor/Marketing Manager Leisure Providers. Participant from scheme 7.3 County Steering Group Draft Terms of Reference Purpose: 1. To strategically steer all 6 Activity Referral Schemes across Worcestershire. 2. To identify risks and barriers for the future sustainability and development of the Activity Referral Schemes, and to seek realistic and appropriate solutions. 3. To support communication between local and geographic adjoining schemes. 4. To ensure that all separate schemes share good practice in terms of delivery and planning and that locality scheme funds are spent appropriately. 6

7 5. To provide the county with a range of appropriate and localised Active Recreation Referral Schemes to contribute to an overall increase in Sport, Active Recreation and general activity levels. Steering Group role: 1. Agree the appropriateness of organisations for inclusion on the locality steering groups. 2. Organise and Chair regular meetings of the County Steering Group. 3. To have a presence at all locality steering groups to ensure continuity. 4. Oversee the ongoing development of the Schemes. 5. Manage and monitor the project budget. 6. Agree local funding against the county protocol. 7. Developing strategies for sustainable funding. 8. Ensure transparency and accountability of consultation, decision making and implementation processes. 9. Monitor and evaluate progress against the targets of the funding organisations 10. Prepare quarterly reports for partner organisations. Steering Group Principles: Membership: 1. Focus on health Inequalities. 2. Based on need. 3. Fair and transparent decision making. 4. Focus on sustainable activity and maintaining participation. Strategic representation from: - The Sports Partnership Herefordshire and Worcestershire - Worcestershire Primary Care Trust - Worcestershire County Council - Herefordshire County Council - Worcester City Council - Malvern hills District Council - Wychavon District council - Redditch Borough Council - Bromsgrove District Council - Wyre Forest District Council Accountability: The group is accountable to the partner organisations through their named representatives. 7

8 Resources: Funding is being sought from Sport England Community Investment Fund, Worcestershire PCT and financial and in-kind contributions from the districts. Administration: 1. The group will be Chaired by the Sports Partnership and PCT 2. Meetings will be held bi-monthly 3. Venues will be provided and meetings serviced by Partners on a rotational basis 4. The terms of reference will be reviewed annually. 8 Worcester City Pilot Scheme success stories. To ensure confidentiality, the names of the participants have been omitted from the following case studies. 8.1 Male 1 Reason for joining the scheme: GP referred due to high blood pressure, high cholesterol, overweight, stress and depression. Never used to walk anywhere. Benefits to Health: Lowered blood pressure, lost 5lbs of weight but body shape has changed, cholesterol has lowered and mood and general mental outlook has improved beyond recognition. Strengths of the scheme: Nutrition session, food log and activity diaries, pedometers, group support and atmosphere. Plans for the future: Leave the car at home (having not used it in 10 weeks), will join the gym, increase walking and would recommend it to anyone. 8.2 Female 1 Reason for joining the scheme: Nurse referred due to diabetes, Thyroid problems, high blood pressure and osteoporosis. Benefits to Health: 100% more mobile, blood pressure lowered and insulin intake lowered, able to walk a mile for the first time in years Strengths of the scheme: Group atmosphere, friendliness of the staff, delivery of scheme, walking, stress and nutrition sessions. Plans for the future: Bought a cross trainer for home use, will continue to walk. 8.3 Female 2 8

9 Reason for joining scheme: Nurse referred due to diabetes, weight issues, high insulin dependency and blood pressure, could not walk 25 metres within becoming out of breath and need to rest. Benefits to Health: 2 stone weight loss, more mobile, now using 30 units of insulin per day, reduced from 146 units, reduced blood pressure medication. Strengths of the scheme: Group atmosphere, confidence to try new activities in a controlled environment, nutrition session. Plans for the future: Plays badminton every week with husband, will maintain lifestyle changes through walking and family activities. 9

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