Exercise referral Elaine McNish – Director of BHFNC
British Heart Foundation National Centre for Physical Activity and Health
Presentation • Role of NIHCE and physical activity guidelines • Background to Exercise Referral guidelines • Implications and areas to consider • Models of delivery • Opportunities
Role of NIHCE • Producing evidence based guidance and advice for health, public health and social care practitioners. • Developing quality standards and performance metrics for those providing and commissioning health, public health and social care services. • Providing a range of informational services for commissioners, practitioners and managers across the spectrum of health and social care.
Role of NIHCE • NICE products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing public health and social care services. • The guidance is expected to be taken into full consideration by health and social care professionals and organisations when making decisions with the person receiving care. However, it is not designed to replace the knowledge and skills of individual professionals.
NIHCE Public Health Guidance on PA • Evidence based • Effective Evidence of • ‘Exceptional value for money’ what works [NICE & Department of Health ] is increasing
A selection of national guidelines recommending physical activity in prevention and management of LTCs..?
More…… Falls Chronic Kidney Disease Premenstrual syndrome Osteoarthritis Chronic Lower Back Pain Osteoporosis Cellulitis in lymphedema
Physical activity promotion options
Intervention Spectrum Universal Targeted Open access Specialist physical activity Demographic services e.g. targeted open Disease-specific leisure groups access e.g. women, Utility based disabled Rehabilitation activity resources individuals and programmes communities Integrated behaviour change programmes The commissioning landscape: the state of play 31
Universal Targeted Specialist services
NICE Exercise Referral Guidance – considerations • The review did not cover ongoing management or rehabilitation following certain health conditions e.g. CHD • There was a always a consideration of cost effectiveness especially in relation to other options • The evidence base had not moved on much from the previous review – not many high quality studies measuring long term impact • Challenges in defining exercise referral - lots of different models and different terminology • Recognition that the main outcome may not be health but no studies to be definitive on impact – need evaluation • Draft guidelines were field tested • This is but one intervention in a suite of NICE guidelines on physical activity
Definition • An assessment to determine activity levels • Referral by health professional to physical activity specialist • Personal assessments involving a specialist service to determine programme • Opportunity to participate in a programme
NICE Public Health Guidance 54: ERS Recommendation 1: Policymakers and • commissioners should not fund ERS for people who are sedentary or inactive but otherwise apparently healthy Primary Care Practitioners • should not refer people who are sedentary or inactive but otherwise apparently healthy to ERS
NICE Public Health Guidance 54 :ERS Recommendation 2: Caveats: • Incorporates core techniques • Policymakers and of NICE Behaviour Change PH commissioners should only Guidance 49 fund ERS for people who • Collects data in line with the are sedentary or inactive essential criteria outlined in and have existing health NOO Standard Evaluation Framework for physical conditions or other factors activity interventions that put them at increased Makes the data collected • risk of ill health available for analysis, monitoring and research to inform future practice
Robust evaluation vital to secure ££ Evaluation of physical activity interventions has been notoriously weak • Poor evaluation design • Process – Impact - Outcomes • Limited long-term follow-up
Ayrshire & Arran Model
NERS Final Chronic Condition Referral Routes & Delivery Options NERS Level 4 Chronic Condition Referral Routes and Delivery Options GP / AHP Condition specific Specialist Physiotherapist /Occupational Therapist Condition specific form completed and sent to NERS coordinator NERS 1:1 Baseline Assessment; Health Questionnaire/Informed Consent Condition specific referral form completed and NERS Coordinators Goal Setting sent to NERS Coordinator checks referral and Assessment tools selected from; assigns to EP TUAG 10 M Walk EQ-5D FACIT Fatigue SPAQ etc. Depending on assessment outcomes and impairments present; Phase IV Obesity/ Mental PSI Falls Stroke 16- Community Back Pain Cancer 16- Cardiac Diabetes 16- Health 16- Prevention 32 week Respiratory Post 16-32 week 32 week Rehabilitation 32 week 32 week 48 week programme Rehabilitation 16-32 programme programme 8-16 week programme programme week programme programme programme 16 week NERS Conditions are suitable for combined delivery Level 3 programme in either exit route sessions or with green partner schemes following 4 th / 8 th week Conditions possibly suitable for combined delivery of evidenced review based PSI FaME and Otago
BHFNC exercise referral toolkit Guidance for: Referring healthcare professionals Exercise professionals Scheme coordinators Commissioners Plus: A guide to evaluating ERS A guide to qualifications Templates forms/letters www.bhfnc- exercisereferral.org.uk
Opportunities • NHS Diabetes Prevention Programme: Providers to deliver structured behavioural change interventions for people at risk of diabetes www.england.nhs.uk/ndpp • NHS Health Checks: Need exit strategies/interventions to support • those at risk of CVD • Wider offer – span intervention spectrum
More systematic & proactive management of Long term conditions (LTCs) 15 million people in England living with at least 2025 - 18 million one long term condition
Counting the cost of LTCs 1 LTC = £1,000 Approximately 50% of GP appointments 64% of outpatient appointments 2 LTCs = £3,000 70% of inpatients bed days 3 LTCs = £8,000
How do we capitalise? • Effective screening method so referral and signposting can occur – PARQ • Better evidence based practice – improve adherence • Right level of intervention for right patient • Training for health professionals – or make it easy for them • Educate and encourage self management • Training qualification review • Understand the needs of inactive and meet their needs – more choice- right offer; right place; right time • Collect evidence of impact but also best practice
Thank you bhfactive.org.uk
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