Lets Get Moving: A Physical Activity Care Pathway PACP

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Lets Get Moving A Physical Activity Care
Pathway (PACP)
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The case for Physical Activity in primary care

• Active adults have
• 2030 reduced risk of premature death
• up to 50 reduced risk of developing major
  chronic diseases such as coronary heart disease,
  stroke, diabetes and some cancers.
• Activity reduces the risk of depression, anxiety
  and enhances mood and self-esteem
• Despite this, the Health Survey for England,
  2006, reported that 60 of men and approximately
  72 of women are insufficiently active to
  benefit their health. Thats 27 million people
  not active enough
• Average cost to each PCT is 5 million /
  year(includes 5 health conditions linked to
  inactivity)
• One in four people in England say they would be
  more active if they were advised to do so by a
  doctor or nurse. There are 185million GP
  consultations per year presenting a significant
  opportunity to promote activity through primary
  are.

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The policy context
The pathway links to existing commitments and
guidance

• Be Active, Be Healthy A Plan for Getting the
  Nation Moving
• Legacy Action Plan target for 2 million more
  active by 2012
• Our NHS Our Future NHS Next Stage Review Lord
  Darzi putting prevention first and promoting
  patient choice
• Healthy Weight, Healthy Lives A Cross-Government
  Strategy for England to tackle obesity
• NICE Guidance 4 commonly used methods to promote
  physical activity 2006
• Marmot Review Post-2010 strategic review of
  health inequalities
• and to other DH initiatives
• Health Check Stop Smoking
• Adult Obesity Care Pathway NHS Life Check

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How the intervention works
The PACP is based on the 2006 NICE Guidance that
endorsed brief interventions in physical activity
in primary care. The key stages are

• Identify inactive adults, using GPPAQ screening
  tool
• assess current Physical Activity levels
• patients aged between 16-74 are eligible
• Provide brief intervention
• using motivational interviewing principles
  (patient lead behaviour change) take into account
  the individuals needs, preferences and
  circumstances.
• provide Lets Get Moving pack to patient
  (benefits of activity and local opportunities),
  patient identifies appropriate activity goals
• Physical Activity opportunities include
  condition specific schemes
• Patients are invited for a follow up consultation
  at regular intervals (at least 3, 6 and 12
  months)

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Practicalities of the Feasibility Pilot

• DH developed and tested appropriate support
  products
• Practitioner training (Physical Activity for
  Health and Motivational Interviewing based
  behaviour change techniques)
• Practitioner/PCT support handbook
• Patient Lets Get Moving pack
• Patient record templates
• Evaluation
• BHF National Centre for Physical Activity and
  Health, Loughborough University
• Assessed feasibility of delivery methods and
  practitioner experience
• Monitored patient throughput
• Analysed cost

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Feasibility Pilot Model

• Recruitment
• Restricted to opportunistic or hypertensive and
  diabetic disease registers for effective
  evaluation
• Screening
• GPs or Practise Nurses screened for inactivity,
  patients completing GPPAQ in consultation
• Brief Intervention
• delivered immediately following screening or
• referred in to the Brief Intervention delivered
  by Practise Nurses or Health Care Assistants
• All outcomes recorded within patient records
• Signposting patient choice based on Lets Get
  Moving pack opportunities
• Follow up
• Letter or text message invites
• Follow with same practitioner as BI

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What the feasibility pilot showed

• Screening 526 adults
• Of which 86 were assessed to be less than
  Active
• Of which 83 were interested in becoming more
  active
• Brief Intervention 315 attended
• Discussion took between 3-21 minutes
• Mean Age 54 (Range 16-84)
• 54, BME, 21 White, (25 missing)
• Gender 59 women, 41 men
• Activity goals set
• 49 leisure centres
• 44 self directed outdoor activity/pedometer
• 6 dance and sports clubs
• 1 condition specific
• Follow up consultation 101 attended
• 62 self reported a physical activity increase
• 59 opted for self directed outdoor activity and
  pedometer 27 went to leisure centres

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Summary of findings

• The pathway helped practitioners raise the topic
  and emphasise the importance of physical activity
  to patients.
• The brief intervention, with the use of
  motivational interviewing techniques, was viewed
  as beneficial and helpful in patients changing
  their physical activity behaviour.
• Many aspects of the pathway were liked,
  considered to be feasible, and were perceived to
  be well received by patients.
• Health practitioners perceived a range of patient
  benefits including weight loss, breathing
  better, reduced blood pressure and improved
  mental health and well-being.
• Lets Get Moving meets the health inequalities
  agenda

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Strategic approach in summary

• Position PACP as an enabling care pathway a
  prevention or disease management tool to address
  multiple public health priorities
• Highlight clinical and economic evidence base
  that PACP can contribute to recognised Vital
  Signs and QOF targets
• Implement highly targeted marketing campaign to
  influence at commissioning of the PACP by PCTs
  and GP Surgeries in line with PCT commissioning
  planning cycle
• Grow evidence base and embed across the regions
  with early adopter PCTs
• Explore possibilities for appropriate national
  targets for Physical Activity
• Engage with wider stakeholders (from royal
  colleges to local authorities) to generate
  interest and encourage ongoing support

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Who are our audiences?
AUDIENCE
DESIRED OUTCOME FOR SUCCESS OF PACP
DECISION MAKERS Directors of Public
Health Directors of Commissioning Chairs of Prof
Exec Committee Practice Managers General
Practitioners
Investment
INFLUENCERS Commissioning Managers (PCT) Public
health leads (PCT and SHA)) DH policy and comms
leads
Advocacy
Commitment
SERVICE DELIVERERS General Practitioners
Practice nurses
INTERESTED INTERMEDIARIES Local
authority Relevant third sector organisations
Promotion
END USERS Inactive adults Patients
Motivation
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Targeted communications strategy
GET..
TO..
BY..
Decision makers
Invest in PACP
proving investment in physical activity can
contribute to the achievement of priority
outcome measures
Influencers
demonstrating that PACP can be used within
primary care to prevent and manage a range of
conditions
Support and advocate PACP
Service deliverers
proving that PACP will be adequately funded,
easy to implement and can contribute to
achievement of outcome measures
Commit to the delivery of PACP
Interested intermediaries
demonstrating how PACP can support their goals
Promote and endorse PACP
Inactive adults
convincing them that physical activity can
improve their health and well-being
Sign up to Lets Get Moving
AUDIENCE
OBJECTIVE
COMMS STRATEGY
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Phased roll-out of PACP
We will provide commissioning materials to all
PCTs in England and encourage take up by all.
In addition we will fund an early adopters
programme with monitoring and evaluation

• One early adopter PCT per region
• Recruitment will include rural and urban,
  spearhead and non-spearhead PCTs
• These can trail blaze to other PCTs in locality
• In addition to using the standard PACP the early
  adopter programme will include trialling the
  intervention in wider primary, secondary and
  acute care environments e.g. Pharmacies