Redbridge Exercise on Referral Scheme Case Study The scheme was set up in September 2008 and was a joint partnership between London Borough of Redbridge (LBR), NHS Redbridge and Vision. The aims and objectives of the scheme are: To introduce physical activity to sedentary people with low/medium risk conditions and help improve their health and wellbeing. Developing the confidence, skills, and motivation customers need to become and remain physically active. Promote activities within the community. This service links to the Obesity Care Pathway and the Physical Activity Care Pathways. STEPS FOR THE CUSTOMER Patients will be referred to the scheme by their GP, and other health care professionals. Once Vision has received the referral form we will book in an initial assessment which will last for one hour. This will be completed at either Wanstead Leisure Centre or Fullwell Cross Leisure Centre. During this assessment the instructors will talk to the customers about their medical history, why they feel they have been sent, what they want to achieve and what they need to change to achieve it. Customers will also undergo a screening test where the instructors will take their; weight, height, blood pressure, resting heart rate, waist and hip circumference. We also complete a wellbeing questionnaire. Once customers have completed their initial assessment they will book in 12 sessions doing a maximum of 2 sessions a week. The sessions range from Monday to Saturday with a mixture of morning daytime and evening classes. Each session will be supervised and the 12 sessions cost a total of 12. Once the customer has completed their 12 sessions they will be book in for a follow up assessment, have their blood pressure, weight, resting heat rate, waist circumference and wellbeing questionnaire taken again and will be offered the option of a reduced membership that will give them unlimited access to the gym, swimming and classes. Customers will also be given information about other physical opportunities within the borough. The customer will then have a further follow up appointment after 6 months where we will complete the physical screening and wellbeing questionnaire and re-establish future goals and targets. We will then send a report to the GP explaining how the customer has progressed over the 6 months.
Below is a table showing the figures from Apr 2009/present Monitoring Information Year 5 Year 1 Year 2 Year 3 Year 4 to date Total Total New Referrals 977 1117 1314 1581 838 5827 People entering scheme 685 811 1003 1204 612 4315 Completers 313 446 559 597 312 2227 DNS Gym Sessions 94 113 107 125 39 478 Un-contactable 175 186 194 218 151 706 Rejected 30 44 49 52 30 205 Did Not Show 212 266 252 297 161 1188 6 month assessment 112 205 279 366 198 1160 Total Referrals 1800 1600 1400 1200 1000 800 Total Referrals Projected 600 400 200 0 We have received a total of 5827 referrals since April 2009 with an average increase of 15% each year and a projected 6% in referral this year.
People Completing 1 st Assessment 1400 1200 1000 800 600 Attending 1st Assessment Projected 400 200 0 We have completed 4315 initial assessment since April 2009 which means we have seen 74% of the referrals that have come through from the GPs DNS Gym Sessions % of people not turing up for their 1st gym session after attending the initial assessment. 14% 12% 1 8% 6% 4% 2% % of people not turing up for their 1st gym session after attending the initial assessment. 11% of people who came for their initial assessment did not start their 1 st gym session. The reasons for this have included; ill health, not meeting our criteria, wanting women only sessions and deciding they didn t want to take part.
Completers 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 % of people completing 12 sessions after attendind 1st assessment % of people who completed 12 sessons after attending their first gym session Projected % completing after attending 1st assessment Projected % completing after attending first gym session. 52% of people who completed their initial assessment finished their 12 sessions and 58% of people that attended their 1 st gym session finished all 12 sessions. 6 Month Assessment 7 6 5 4 3 % completing 6 month assessment Projected 2 1 52% of people who completed their 12 sessions completed a six month assessment. This has come up from 39% in 2009 to 61% in 2012.
Cancelled Appointments 25% 2 15% Cancelled Appointments 1 5% We have a cancellation rate on average of 22% since the scheme has started. Rejected % of rejected referrals 4% 4% 3% 3% 2% 2% 1% 1% % of rejected referrals On average 4% of our referrals are rejected. The reasons for this range from patients being too young, patients not meeting our inclusion criteria or GP surgeries being outside of Redbridge.
Age Below is a table that s shows a percentage of what age people are when they come for their initial assessment. The scheme can accept anyone above the age of 16 years old. TOTAL 25. 20. 15. 10. TOTAL 5. 0. 16-19 20-29 30-39 40-49 50-59 60-69 70+ Ethnicity Below is a table which shows the percentage of different ethnicities coming for the initial assessment. This matches the makeup of Redbridge. 2012/13 35% 3 25% 2 15% 1 5% 2012/13
Gender Gender Male Female The split between male and female is 43% male and 57% female. This has been very consistent since 2009. One of our targets is to try and reduce the weight, blood pressure or waist circumference in 5 of our customers at the 6 month stage. Below is a table showing the amount of people that either lost weight, reduced their blood pressure or waist circumference and whether people lost one, two, three or none of these. These figures are from Apr 2012-2013 Numbers Percentage Weight 214 58% Blood Pressure 188 51% Waist Circumference 198 54% One 94 25% Two 116 32% All three 92 25% None 64 17% 82% of people lost weight, reduced their blood pressure or reduced their waist circumference. Also as well as seeing an improvement physically customers have also seen an improvement in their general wellbeing as proved in the evaluation that was completed by Southbank University in 2010
Challenges Overcome Over the last five years the scheme has had to overcome a number of challenges to improve performance and meet the targets that have been set. Appropriate Referrals In order to keep the number of inappropriate referrals to a minimum the Referral Scheme Manager went to every surgery and spoke to all GPs about who will meet the inclusion criteria and emphasise that the scheme only want people that are generally interested in participating in physical activity. By having good communication with the GPs inappropriate referrals have been around 3-4% every year. Six Week Assessments With every session being supervised by at least one instructor there is allocated time before and after most sessions for 6 week assessments to be completed. This makes it a lot easier to meet with customers on their last or second to last session. It also proves very effect for signing them on to a reduced membership and cuts down admin as we do not have to chase people to book appointments. Six Month Assessments Trying to catch up with people for a six moth assessment can prove time consuming and involve phone calls and letters being sent. Recently we have found a way of blocking a customer s membership card which flashes a message up to reception staff saying that the customer needs to book a six month assessment. Only once the customer has attended the assessment will the membership card be unblocked. This has seen an increase of assessment being booked and attended and has also saved time and money regarding admin and postage. Partnership Working Over the last twelve months we have delivered numerous sessions with groups ranging from body MOTs, blood pressure checks, talks and festivals. Below is a list of different groups we have worked with. Sports and Health Team Public Health Tea Redbridge Link Mellmead House Flying Solo Age UK Root Cause Redbridge Early Intervention Team Pulmonary Rehab Physiotherapy Department Cardiac Rehabilitation Team The Parkinson s Group
For the future For 2014/15 we are looking to add to the scheme in a number of areas: Introducing a structured weight management programme which will work alongside the physical activity sessions and will improve the schemes weight loss results. Introducing women only session to the scheme. This will make the scheme more accessible and will make more people feel comfortable about participating in physical activity. Updating our computer software so we can have a paperless referral system and make our data collection more efficient.