GP James Higgins explains how a CCG-wide project to offer fitness ‘prescriptions’ is transforming care at his practice – and why it should be a blueprint for the entire NHS
Like every other practice in the country, Brinnington Surgery in Stockport deals each day with the tsunami of chronic ill health largely brought on by the typical British lifestyle of bad diet, smoking, alcohol and lack of exercise. GPs across the UK offer routine preventative advice where they can, but how many patients act on it? It is frustrating, to say the least.
However, we have an important weapon in our fight. The practice is part of a CCG-wide initiative funded by Public Health Stockport. We’re one of 40 GP practices helping people with chronic health conditions to get and stay active. When it first started, 25 years ago, Brinnington, as a priority area for health improvement, was one of the first to take it up. We make physical activity referrals to a not-for-profit enterprise, Life Leisure, which also takes referrals from cardiac rehab services, physiotherapists and weight management services.
The criteria are broad enough to allow us to refer most people for whom we feel exercise would be beneficial and the offer of proactive support to help make a change is usually well-received. A simple, short proforma to refer is all it takes and then Life Leisure does the rest. At present, we case-find opportunistically, offering referral when we identify a need during a consultation. In future, we hope our excellent practice admin team will begin identifying people based on recorded risk factors (BMI, blood pressure, Hba1c levels, etc.) and contacting them to offer them this additional support – even if they have not attended for a consultation.
The proactive support is what makes this different from simply advising someone to ‘join a gym’ or ‘get more exercise’. Once referred, patients are assigned a Life Leisure coach who works with them on a tailored programme of healthy eating and exercise that enables them to progress at their own pace. They have the support and follow-up that I cannot give them as a GP. Not everybody likes the gym, so patients are offered a range of activities such as swimming, walking, running, team sports and keep-fit classes – whatever keeps them on track in the fight back to normal health.
Many of my patients have not taken any serious physical exercise since leaving school, and would not dream of joining a gym, so building-in other activities is really important, as is keeping the exercise local. Many are on low incomes with stressful jobs and no car; the last thing they want is to be told to go out in the evening to visit a gym that is two or three bus rides away.
Actively transforming people’s health
Forty-three-year-old John Lee is a great example of how physical activity referrals can transform people’s health. Twelve months ago, he was found to be pre-diabetic with an Hba1c level of 47. At 5ft 4in and weighing 16.6 stone, he was the classic ‘heart attack waiting to happen’. With help from a Life Leisure instructor he has shed 2.8 stone, ditched his fatty diet and joined a local football team, which he loves. He has reversed his risk of diabetes, improved his mental health and hasn’t used his inhaler for months. Thanks to the support from Life Leisure, he has been able to stick to his regime.
A welcome side benefit is that he has saved the NHS thousands of pounds a year on drugs – not to mention the cost of in-patient stays had he gone on to suffer a heart attack or stroke.
Making physical activity a priority
In the last 12 months alone, GPs and other health organisations in Stockport have made 1,583 physical activity referrals to the scheme and 73% of patients signed up for it. Of those who completed six months (711) 78% reported an increase in physical activity with an average reduction of 71 minutes in the time spent sitting each day. There was an average BMI reduction of 1.4 points. An overwhelming 98% of participants said they would recommend the scheme to family or friends.
Physical activity referrals have become an integral part of our work at Brinnington Surgery. I cannot imagine not being able to recommend them to my patients. I would estimate around half of the adults on our 8,700-patient list could benefit from it. If we could get everyone on our list exercising more, the reduction in prescription and clinical care costs alone could be enormous. If it were rolled out across the NHS in the UK, the savings would be huge and the benefits to the nation’s health, incalculable.
Let me give the last word to my patient John Lee. He said, “The scheme gave me the structure, support and impetus to make the changes I needed to. It changed – and probably saved – my life.”