7 minute read
Fitness & Health
IN DEPTH
FITNESS & HEALTH
DEMAND STILL
By Caroline Roberts UP FOR
Covid-19 and a changing NHS local landscape present challenges for operators running exercise referral programmes and are prompting changes in their delivery EXERCISE REFERRAL
efore the fi rst lockdown, B exercise referral numbers were at an all-time high, says Stuart Stokes, managing director of ReferAll, an online platform providing a patient pathway from health services to exercise providers. “All those people got stuck in the system, and throughout the pandemic, people have still been suff ering from coronary heart disease, strokes and cancer and needing referrals,” he says.
It all adds up to large pent-up demand for the exercise programmes that can be a lifeline for those suff ering from chronic health conditions. And this is without the rehabilitation requirements of the many thousands aff ected by ongoing symptoms related to long Covid.
Operators, meanwhile, are adapting to reduced physical capacity due to Covid restrictions and the need to balance the needs of referral clients with those of other customers. Alongside these factors is the rise in social prescribing as part of local NHS services and the possibility that it could be used as an alternative option to referring clients onto formal exercise programmes.
Some operators may now need to rationalise the way in-person referral sessions are delivered, says Stokes. “What we sometimes see is a Level 4 instructor delivering a falls prevention class, followed by a cardiac rehab and then a pulmonary rehab class, each with four people in them. Th ese all involve really gentle exercise, so I would question whether it would be better to combine these classes as you’re using three times the resource you really need.
“It’s also important to ask yourself if capacity restrictions allow you to work effi ciently with the current and proposed number of referrals. Don’t open the fl oodgates to referrals if
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FITNESS & HEALTH
there is a risk that poor experience will follow.”
Many operators dealing with large numbers of referrals see the shift to online off ers brought about by the pandemic as a positive thing for referral schemes. Before the pandemic, CIMSPA partner Places Leisure had around 4,500 referrals every year for programmes such as cardiac, cancer and stroke rehabilitation, chronic pain and falls prevention.
“Going forward, our schemes will be delivered using a blend of on-site delivery, screen time and phone calls. We’re also using text messages to boost motivation and welcome people back,” says Sarah Roberts, fi tness operations manager.
She believes that this blended approach will benefi t clients and the organisation. “It’s early days, but we feel that people have come to expect changes in the way that programmes and schemes operate, and remote support makes them more fl exible. I actually think that this will increase our reach. Previously people had to be well enough to visit the centre but, by supporting them remotely, their journey to health can start earlier and they can make health gains in their own home with no travel needed. Th is will also grow confi dence so that when the time comes to for them to visit the centre, it’s not such a big step.”
At another CIMSPA partner organisation, GLL, the number of new referrals is now increasing quickly, says regional health intervention manager Lynn Almond. “Our good relationships with referrers have meant that we’ve hit the ground running, with really positive engagement with both the referrers and the potential participants.
“Everyone that was part of our referral programme prior to lockdown has been re-engaged to restart. Th ose that were referred but had not started are being hybrid off ering in centres. We need to be agile, providing services that can respond to local needs whatever the landscape.” Th e operator’s new Better Health suite of website resources and an online health assessment tool are also helping to support the aims of its referral scheme, she adds.
“Th e challenges ahead include being able to build and maintain the programmes’ fi nancial sustainability, and to ensure we’re linking in with the new NHS integrated care systems to deliver support that contributes to local health needs.”
contacted, triaged and restratifi ed to see if there’s a need for further information from their healthcare professional. During the pandemic, we have reimagined our service to provide a
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Integrated care systems are an attempt to build more partnerships between organisations meeting health and welfare needs across an area and to provide more joined-up care. Social prescribing forms part of these integrated systems. It involves health services and other agencies referring people to a link worker who then refers them on to local services or community groups, including those promoting exercise. Social prescribing has been around for some time, but it has been the focus of renewed attention and funding since it was incorporated into the NHS Long Term Plan in 2019 as part of a new model of more personalised care. Th ere are now more than 1,300 social prescribing link workers in post across England and the plan is for at least 900,000 people to be referred to social prescribing by 2023/24.
A concern for the sectors is that commissioners and referrers might see social prescribing as a substitute for formal exercise referral programmes, and that link workers may not appreciate the value of a structured programme delivered by a qualifi ed fi tness professional. However, GLL’s Almond sees it as an opportunity. “Work with the newly emerging social prescribing workforce has already started and the services we off er complement the work that they do. Working with the link workers can help identify individuals who may benefi t from specialist programmes such our referral schemes through to our universal centre programmes. Pre-pandemic we were seeing local relationships being built that allowed link workers to support their participants in our centres.”
Th is new wave of social prescribing makes it even more important that providers can evidence that what they are doing makes an impact, says Stokes. “It’s important to understand your local social prescribing environment. It may well be that link workers don’t have the necessary clinical information at hand to refer into your medical-led programmes but there’s always the opportunity for referees to access activities in your wider off er. When they do fl ow into your facility, aim to identify those with a greater need. It may be that you need to go back to the referring partner for more information so they can be channelled into your referral programme, but at least the conversation has started. More conversations will lead to more active people and that should be embraced.”
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How new technology can aid remote delivery
CIMSPA partner organisation Everyone Active has joined forces with the creators of a new exercise prescription app to support the reopening of its exercise referral service by enabling staff to monitor participants’ progress remotely.
The EXi app is approved by the NHS and backed by a number of organisations, including ukactive and Sport England. It can be downloaded free by anyone and can be tailored to 23 diff erent long-term health conditions. The app asks users to enter health information, measures resting heart rate, and has a fi tness testing function to assess base level fi tness. It then generates a personalised 12-week exercise plan.
Everyone Active has made the app available to all customers as part of its digital off er, Everyone on Demand, which was launched in May 2020. But it’s especially useful for those on exercise referral programmes as fi tness staff have access to users’ health and activity data in real-time via the secure and GDPRcompliant web-based data portal. The user enters a bespoke Everyone Active centre code at the start, which links their data to the appropriate team.
“EXi is a game changer for us as it enables our trainers to off er their exercise referral clients a tried and trusted digital health solution,” says Ben Beevers, Everyone Active group development director. “The app accurately tracks people’s physical activity throughout the week and delivers the activity and health outcome data directly to our fi tness team so we can clearly see how people are getting on and where any extra help or guidance is needed.”
