Regional Mapping Exercise Referral Schemes in the West Midlands

1. Regional MappingExercise Referral Schemes in the West Midlands Suzanne Gardner Regional Physical Activity Co-ordinator West Midlands

2. Background • NICE Guidance • Identify schemes, good practice and challenges • How can schemes be supported? • Improved networking and sharing best practice • Inform decision making on potential national research programme into Exercise Referral • Undertaken August 2006 via questionnaire

3. 14 PCT/LA led schemes 5 smaller scale schemes run by Private providers Location and Duration of Schemes

4. Lead Agency

5. Partners in Schemes

6. Similarities 11 schemes aim to promote and increase physical activity levels 10 schemes aim to increase the recognition of the benefits of physical activity on health and well being Differences 4 schemes target specific health conditions within the aims of the scheme 3 schemes cite long term behaviour change as a direct aim 2 schemes specifically target the sedentary population within the schemes aims. The Aims of Schemes

7. Specific Target Groups for Schemes

8. Most frequent referrer’s 64.3% GPs 42.7% Practice Nurses 7.1% Physio’s Referral Routes

9. Length of Referral

10. Total number of settings 144+ across the region Range of settings per scheme 3 – 19+ Other settings included schools, GP Surgery, YMCA, Action Heart Facilities and settings used by schemes

11. Activities on offer to participants

12. Charges • Half of the schemes in the region do not charge for assessments • 1 scheme does not charge for assessments or sessions meaning it is fully subsidised for participants • 1 scheme utilises an all in fee of £10 for accessing the scheme. • 5 of the schemes use a leisure card system to provide discounts for participants • 9 of the schemes offer free sessions as part of the exercise referral activities, this ranges from free walks to free swimming sessions and Action Heart sessions. • 6 of the schemes offer subsidy’s to participants over and above the leisure card systems offered. These subsidies are as much as 50% discount in some areas although discounts may be restricted to off peak times. • 2 schemes utilise voucher schemes for sessions as part of the subsidy system.

13. NQAF • 92.9% schemes reported adherence to NQAF • 78.5% of schemes provide feedback to the referrer • 1/14 schemes is aware of the referrer holding a follow up appointment with participant after the referral period

14. Staff • 134+ people identified as working on schemes across the West Midlands • Range of people working on schemes: 2 – 47 people • Includes; Schemes co-ordinators, physical activity leads, instructors/assessors, outreach consultants, leisure managers and health professionals • Range of hours spent on schemes ranges from 7+ - 340 – 600 hours • Number of hours spent on exercise referral = 1297.75 – 156.75+ hours per week across the region

15. Other Courses; Future Fit GP referral, YMCA, Premier Fitness Exercise Referral, L3 Disabled persons, BA hons degrees, Advanced Gym Instructor, YMCA Level 3 Fitness Knowledge, 1 day training WSHPS benefits if activity and behaviour change, day 2 training - BACR, medical conditions , referral conditions and medication. The exercise referral qualifications recognised by the Register of Exercise professionals are currently; CYQ Exercise Referral qualification Wright Foundation Exercise Referral qualification Future Fit Exercise Referral qualification Envisage Exercise Referral Systems qualification Staff Qualifications

16. Are staff accredited to REP’s? CPD 64.3% of schemes provide in house training for staff Examples include; CHD,mental health, physiotherapy, diabetes, nutrition ,rowing techniques, medication training, Specialist population groups, obesity management, facilitating change and smoking cessation, chronic back pain management provided by locality health professionals/leads, specialists and external companies. REP’s and CPD

17. Core Costs • 5/14 schemes were unable to attribute core costs to their scheme, in part this is due to instructor time being incorporated within full time roles within centres, venues etc being given free of charge through partnerships etc. • Total costs identified by schemes was £323,763 - £328,763 across the region. • 12,128 people participated in schemes during the last year of evaluation – based on the figures given by the schemes this would equate to a cost of £26.70 - £27.11 for each person accessing the scheme. • If the participant figures for the schemes unable to identify costs at this point are removed from the equation the average cost per person accessing schemes is £57.94 - £58.83 (based on 5588). • This is likely to be a conservative estimate on costs.

18. Evaluation and monitoring • 92.9% schemes evaluated, majority of which is internally • 85.7% of schemes have specific targets set to work to. • Ranges from LPSA, SLA, local and scheme based targets • 21.5% have reviewed cost effectiveness • No schemes currently part of research programme

19. What is being monitored

20. Monitoring Information • Throughputs range from 20 – 3,500 • 12,243 people have accessed scheme in last monitoring year, equates to 0.02% of regions popultation • Adherence rates range from unknown – 63% • Half schemes could not provide adherence data • 1 scheme monitored longer term adherence to 6 months (54%)

21. Successes

22. Challenges and Future Development • Development • Monitoring, Evaluation & benchmarking • Adherence to NICE guidance • Training costs and staff retention • Capacity of schemes • Long term funding • LEAP Findings? • Flow diagrams of referral processes • What makes up an effective assessment/consultation?