Active Nation Exercise Referral Scheme Year 1 What has been achieved?

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1 Active Nation Exercise Referral Scheme Year 1 What has been achieved? What is the Scheme about? The Exercise Referral Scheme opened it s doors to referrals in May last year to adults who, due to a variety of chronic medical conditions, needed an intensive, safe and structured programme of support in order to help them become habitually more physically active at levels that would be beneficial to their health. The programme itself involves ten weeks of support from the Exercise Referral Scheme Team at Active Nation. The ten weeks start when the patient attends their first face-to-face appointment (held at one of the following; Bitterne Leisure Centre, Chamberlayne Leisure Centre or the Quays Swimming and Diving Complex). It consists of an assessment, looking at their health issues that may limit their ability to do exercise as well as barriers to being active e.g. shift working, lack of confidence, previous exercise experience, lack of time, family pressures etc. Time is spent with each individual at the start to understand where they are coming from and to agree a plan that helps them get to where they want to in terms of physical activity levels. A big part of this involves combining what they can do with what they would like to do within the context of their lives. The Scheme actively promotes free/low cost options such as walking, cycling, gardening, playing with the kids etc. There is also signposting to a variety of other clubs/groups across the city including Sustrans who offer guided walks and cycling activities. In addition, those referred are also offered one of Active Nation s memberships which has been designed specifically for these patients and allows them access to all of Active Nation s leisure venues for a variety of activities (e.g. swimming, gym, aqua, low intensity circuit training, flex and tone or Tai-chi). Over the following ten weeks, patients are contacted on a regular basis to monitor how they are progressing and keep them motivated. This is done via phone, text or or indeed face-to-face if the Team feel it is necessary and/or they see them around the venues in the supervised activities. At the end of the ten weeks, patients are then invited back in to one of the leisure venues to do a final assessment which looks at what the patient has achieved to date, repeat key health related measures where applicable e.g. self-efficacy, BMI, blood pressure etc. and to agree how they will continue with their plan. Feedback on the patient s journey and progress is provided to the referrer so they can be monitored or followed up as necessary, by the practice. Who have we seen? Between May 2012 and April 2013 a total of 649 were referred and of these 605 (93%) were accepted on to the Exercise Referral Scheme. This is shown in figure 1 below.

2 Figure 1: Total Number of Referrals vs. Number of Accepted Referrals Although the Exercise Referral Scheme had an initial slow start to receiving referrals, it quickly jumped from 21 referrals in June to 75 in July. There was a slight drop in December as would be expected due to the Christmas holidays before an increase in January where 82 referrals were received in to the scheme making it the highest referring month. Although the majority of referrals were accepted onto the Scheme, the main reasons for non-acceptance were as follows: Patient did not meeting the referral criteria Patient was already active Patient did not wishing to participate Patient was not suitable/inappropriate for the scheme, needing additional/different support than provided by the service. Figure 2 below shows the number of patients who attended their initial assessment appointment. As can be seen, only 70% (426) attended their initial assessment. Figure 2: Total Referrals Accepted Vs. Number Receiving Initial Assessment

3 The two main reasons for this drop in the number who attend their first appointment is largely down to patients: not being able to be contacted in order for us to be able to book them into their first appointment or failing to turn up to an appointment that has been booked. Three attempts are made to contact the patient to try and book or re-book an appointment. If that is unsuccessful, then the patient is deemed to have chosen to exit the Scheme and the referrer is notified of this. Figures 3 below shows the overall numbers of patients who have completed the 10 week programme, as well as those dropping out or yet to finish. Figure 3: Retention of patients through the 10 week programme The results show the differences between patients having their initial assessment and then those either completing the scheme or dropping out. There has been a fairly significant drop out and this could be due to: Patients not being ready to engage in a referral programme (these patients need to be clear what they are being referred to and for what reason before completing the referral form) A number of patients have had medical conditions (such as operations/further complications to their conditions) which has meant they were not able to continue with their programme A large majority of patients were under the impression that they could participate in leisure centre activities for free and when they were told of the cost implication at their initial assessment they were unwilling to pay. Although a patient can participate in the scheme through other means of exercise, many of which have little or no costs associated with them, many found this unacceptable. A considerable number of patients are not contactable or do not respond to our courtesy calls after the initial assessment. After three contact attempts and if we can see that their 10 week account isn t being used we will class them as a drop out. It can also be very difficult to get patients to commence their 10 weeks of activity at point of initial assessment due to medical reasons, work, holidays, childcare etc. This isn t ideal as it means their motivation levels often drop but it also makes it increasingly difficult for us to support them and monitor their progress. As a result there are quite a few patients still currently trying to complete the goals agreed in their 10 week support programme.

4 Figure 4: Number of Patients Completing 10 weeks Vs. Number Achieving >=3x30 mins of Activity What is being achieved? We are pleased to be able to report that for those individuals who engage with the programme and complete their goals as part of the 10 week support programme in the Scheme, 69% of patients are being active in 3x30 minutes or more physical activity a week. This is particularly pleasing to see considering the vast majority of patients have come from doing very little or no activity. In addition, we also contact patients at 6 months after they have completed the programme to find out how they are doing and as part of our overall evaluation of the service. Figure 5 below shows the data we have to date. Figure 5: 6 Month Data

5 From the graph it is clear to see that we have difficulties again in contacting patients and establishing whether they are still active as there are a large number of follow ups still outstanding. Although the information we collect is self-reported, it is encouraging to see that approximately 61% of the patients contacted at 6 months are still maintaining a minimum of 3x30 minutes of activity a week. Are we getting to the people in most need? Figure 6 below shows the number of patients we have seen from the most deprived areas of Southampton, namely IMD quintiles 1 & 2. Figure 6: Numbers of Referrals in Areas of Deprivation As you can see, of the 469 referrals accepted, 230 (53%) have been from patients included in quintiles 1&2. The reasons for this are likely to be many such as finances, accessibility to venues, general engagement / attitude to the scheme etc. This is lower than we would like and we are working hard to improve on this and would welcome any feedback or suggestions you can make to help us better understand what we can do to improve. We are also aware that fairly large number of patients from quintiles 1&2 are dropping out of the scheme early, although some are still left to complete (see Figure 7 below). Patients from these quintiles are quite often the hardest to contact for an initial assessment and to contact thereafter so it is quite difficult for us to know how we can improve what we offer as a service to these individuals.

6 Figure 7: Completion and Drop out Numbers within Quintiles 1&2 In summary Although the Exercise Referral Scheme appeared to get off to a bit of a slow start in terms of the number of referrals received, this soon picked up so many thanks to you all for continued support of the Scheme. We are looking to improve the number of people who attend their first appointment and reduce the number who do not attend by contacting patients via letter with information about the scheme asking them to contact the team to make an appointment for their first assessment. To reduce the number of patients who drop out early from the Scheme, we are planning to build in a more formal mid-point assessment. We believe that 10 weeks may seem like a long time for some individuals who are currently doing very little and may have limited motivation or indeed self-confidence, to keep going with their goals. Hence we will be introducing a mini-assessment with them at week 5 if not before to hopefully keep them motivated and on track. Despite the relatively high dropout rate for the scheme, the feedback from patients successfully completing the scheme has been extremely positive and it would seem that many of these continue to be active up to 6 months after they have finished their programme with us. We intend to work closely with those of you who are based in areas of deprivation to try and understand what we can do better to support your patients and keep them motivated and engaged. The activities on offer to patients to help them achieve their goals has developed over the year to include more walks/cycle rides led by Sustrans and other groups/organisations as well as what we have been able to provide such as supervised gym sessions, a flex and tone class and a Tai-chi class. We have also tried to help patients using the Quays Leisure Centre by introducing a car park permit to help break down the barrier of parking costs. Remember, we are also here to help you support your patients as well as providing a service and so if there is anything we can do to help, please contact us. For further information regarding the exercise referral scheme please contact Sam Austreng on: sam.austreng@activenation.org.uk Telephone: