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Regional Mapping Exercise Referral Schemes in the West Midlands. Suzanne Gardner Regional Physical Activity Co-ordinator West Midlands. Background. NICE Guidance Identify schemes, good practice and challenges How can schemes be supported? Improved networking and sharing best practice - PowerPoint PPT Presentation
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Regional MappingExercise Referral Schemes in the
West MidlandsSuzanne Gardner
Regional Physical Activity Co-ordinator
West Midlands
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
Location and Duration of Schemes
• 14 PCT/LA led schemes
• 5 smaller scale schemes run by Private providers
Lead Agency
Acute Trust0%
Private Leisure0%
Voluntary Sector0% Other
21.5%
Local Authority35.7%
PCT42.8%
Partners in Schemes
100% 100%
21.5%
7.1%
21.5%21.5%14.2%14.2%
7.1%
0%
20%
40%
60%
80%
100%
120%
Partners in schemes
% o
f S
chem
es
Partner ResourcesLocal Authority Co-ordination staff,
instructors, funding, discounted/concessionary rates, evaluation, training, development, management and admin
PCT Co-ordination, staff, funding, referrals, expertise, publicity, training
Private sector fitness Concessionary rates
Acute Health Trust Expertise and referrals
Voluntary Sector Instructors and venues
Leisure Trusts Venues, instructors, concessionary rates
Colleges/universities/Schools Venues, instructors, training and equipment
The Aims of Schemes
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.
Specific Target Groups for Schemes
78.5%
64.3%
92.9% 92.9% 92.9% 92.9%
57.1%
21.5%
85.7%78.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%P
eopl
e w
ho a
rese
dent
ary
Peo
ple
with
CH
D
Peo
ple
at r
isk
ofC
HD
Peo
ple
who
are
over
wei
ght
orob
ese
Peo
ple
with
Dia
bete
s
Peo
ple
with
Mus
culo
skel
etal
cond
ition
s
Peo
ple
with
Chr
onic
fatig
ue/M
E
Peo
ple
at r
isk
offa
lling
Peo
ple
with
Men
tal H
ealth
Con
ditio
ns
Oth
er
Health conditions targetted by schemes
% o
f sc
hem
es
Referral Routes
100.0%
85.7%
28.5%28.5%
46.1%53.8%
23.0%15.4%
53.8%46.1%
28.5%
46.1%
7.7%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Health Professionals able to refer to schemes
% o
f sch
em
es
Most frequent referrer’s
• 64.3% GPs• 42.7%
Practice Nurses
• 7.1% Physio’s
Length of Referral
7.1%
14.2%
71.4%
7.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
4 weeks 6 weeks 8 weeks 10weeks
12weeks
14weeks
Other
No of weks participants spend on scheme
% o
f sch
em
es
Facilities and settings used by schemes
100.0%
21.5%
0.0%
78.5%
50.0%
21.5%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Facilities and Settings used by schemes
% o
f sc
hem
es
• Total number of settings 144+ across the region
• Range of settings per scheme 3 – 19+
• Other settings included schools, GP Surgery, YMCA, Action Heart
Activities on offer to participants
100.0%
14.2%
71.4%78.5%
28.5%
57.1%
21.5%14.2%
21.5%
7.1%14.2%
21.5%14.2%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Activities available
% o
f sch
em
es o
fferi
ng
acti
vit
ies
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.
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
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
Staff QualificationsOther 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
14.2%
92.9%
78.5%
28.5%35.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CYQ ExerciseReferral
WrightFoundationExerciseReferral
Cardiac RehabPhase IV
Gayton GroupExerciseReferral
Other
Courses utilised to train exercise referral staff
% o
f sc
hem
es
REP’s and CPDAre 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.
Yes, 78.5%
No,
Unsure, 14.2%
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.
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
What is being monitored92.9%
42.8%
71.4%
42.8%
71.4%
57.1%50.0%
21.5%
7.1%7.1%
42.8%
14.2%
35.7%
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%
100.0%
Monitoring
No
. o
f sc
hem
es
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%)
Successes
7.1%
42.8%
21.5%
28.5%
21.5%
14.2%
28.5%
7.1%
7.1%
14.2%
7.1%
14.2%
7.1%
21.5%
7.1%
7.1%
0.0% 5.0% 10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Increasing participants activity levels
Range and commitment of referrers
Range of activity options
Commitment and skill of staff
Evaluation and monitoring
Geographical coverage
Commitment of partners
Supporting resources
Targeting of key groups
Size of scheme
Improving participants physiological well being
Funding
Follow up of participants
Quality of service
Standardisation of processes
Subsidy to participants
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?