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Oxfordshire Sport and Physical Activity September 2015
Oxfordshire Sport and Physical – Exercise on Referral Group
Oxfordshire Exercise on Referral Scheme Clinicians Guide: 3rd Edition
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Oxfordshire Exercise on Referral Scheme: Clinicians Guide
Contents: Introduction to the scheme - - - - page 2
Full inclusion and exclusion criteria - - - page 3
Referral form - - - - - - - pages 4 - 5
Appendix 1 Practice sign-up form - - - - page 6
Appendix 2 Individual clinician sign-up form - - page 7
Appendix 3 Liability - - - - - - page 8
Appendix 4 Quality Standards - - - - page 9
Appendix 5 List of providers - - - - pages 10-15
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Introduction: Who can refer?
Any health professional that has access to the patient’s medical records and can fully complete all sections of the referral form. For example GP, practice nurse, physiotherapist
Who can be referred? See full inclusion and exclusion criteria over-page.
Patient must be adult, not meeting activity guidelines and physically able to exercise
They must have a stable long term condition. How to refer?
Complete the referral form with all details and your signature.
Give the form to the patient and ask them to sign it.
The patient then follows the link www.oxfordshiresport.org/exercise to find their local suitable leisure provider (regularly updated website page) and contacts them directly to arrange their initial appointment.
The patient must have the fully completed and signed form with them at their first appointment with the leisure provider.
Who operates the scheme? This is a joint scheme between Cherwell District Council, Oxford City Council, West Oxfordshire District Council, South Oxfordshire District Council, Vale of White Horse District Council and participating local leisure providers. The Scheme is based on national guidance from the following organisations
British Heart Foundation; for further information on their guidance
British Association for Cardiovascular Prevention and Rehabilitation (BACPR); for further information on their guidance
National Quality Assurance Framework for exercise on referral All leisure staff who deliver the scheme are Register for Exercise Professionals (REPs) registered to at least level III in Exercise on Referral. What will patients receive?
Risk assessment and personalised programme with a suitably qualified exercise professional
Reduced price access to leisure facilities
Monitoring and assessment throughout and exit interview on completion of programme
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INCLUSION CRITERIA Patients are eligible for referral if they meet ALL of the following criteria:
are 16+ years of age
are not achieving 90 minutes of moderate exercise a week.
are sufficiently motivated to access the scheme and are physically able to access the scheme & complete 3 month’s appropriate activity
AND present with at least one of the following conditions; Cardiovascular disease Such as;
At least six months post myocardial infarction/cardiac surgery/PCI or patient has been discharged from phase III cardiac rehab programme. Patients need to be symptom free.
Stable angina
Controlled hypertension
Cerebral vascular accident
Peripheral vascular disease (e.g. claudication)
Stable heart failure (exercise programme offered if suitable staff are available)
Obesity BMI >30
Waist circumference: Caucasian men >102cm/40 inches, Caucasian women >88cm/34.5 inches, Asian men >90cm/35.5 inches, Asian women >80cm/31.5 inches
Metabolic disorders Such as Diabetes or thyroid disorders
Mental health problems Such as depression or anxiety
Musculoskeletal disease Osteo-arthritis, rheumatoid-arthritis, osteopaenia
Mild to moderate osteoporosis with no history of fractures
Respiratory disease Mild/moderate chronic obstructive pulmonary disease (COPD), having successfully
completed a programme of pulmonary rehab
Asthma, Cystic Fibrosis or interstitial lung disease
Neurological disorders Such as Multiple sclerosis or ME
Exclusion Criteria
Unstable or poorly controlled diseases (such as diabetes, asthma or angina, heart failure)
Hypertension: resting systolic >180mmHg or diastolic >100mmHg
Uncontrolled arrhythmias or resting heart rate >100bpm
Ventricular or aortic aneurism
Acute injury or sports rehabilitation
Neuromuscular pain exacerbated by exercise or not treated by physiotherapy
Symptomatic hypotension
An uncontrolled mental health condition Exercise Professionals may refuse to accept referrals not meeting the above criteria or, following initial assessment & in accordance with their professional guidelines, if the patient is at high risk of suffering an adverse event. In all such cases detailed, written rationale will be provided to you
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OXFORDSHIRE EXERCISE REFERRAL FORM
This form should be completed and signed by the referring practitioner and then handed to the patient. It is the responsibility of the patient to contact the chosen provider and arrange a mutually convenient time and date for an initial assessment* This form MUST be given to the Exercise Professional at the initial assessment.
* Find your local leisure centre and provider details at www.oxspa.co.uk/exercise
or call 01865 252606 if you do not have internet access.
PATIENT DETAILS: please provide all of the information below.
(PLEASE PRINT)
Surname ………………………………………………………………………………….. First Name ………………………………………………………………………………… Address ………………………………………………………………………………… ……………………………………………………………………………………………... Post Code ……………………………….. NHS Number ………………………. Tel…………………………………………………….. Sex: Male Female Other D.O.B: / / Height m Weight kg BMI BP / HR……..
Please turn over to complete form
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Reason for referral (PLEASE PRINT): e.g. High BMI, controlled hypertension, anxiety….
Medication: (write in or print list for patient)
Cautions/additional comments:
Referrer Details: I confirm that a full client history has been taken and they have been assessed to ensure the inclusion/exclusion criteria have been met. Referral Site (GP Practice)………………………………………………………. Name of Referring Practitioner (please print):
…………………………………………………………………………………………..
Signature……………………………………………………………………………..
Contact number……………………………………………………..
Date……………………………………..
The patient has given consent to share medical, weight and fitness details with their fitness instructor The patient has given consent for their anonymised data to be shared for evaluation purposes Yes No Patient signature…………………………………………………………………….
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APPENDIX 1
EXERCISE REFERRAL SCHEME – Practice Sign up Form To register your practice as a referrer to the Oxfordshire Exercise Referral Scheme please complete the details below and return to; Physical Activity Team, Oxfordshire Sport and Physical Activity, C/O Community
Services Directorate, Oxford City Council, Horspath Road, Oxford, OX4 2RH
We have read the “Oxfordshire Exercise on Referral: Clinicians Guide” and agree to comply with the stated referral criteria and patient enrolment process. PRACTICE NAME:
LEAD GP:
SIGNED:
ADDRESS:
TELEPHONE NO:
EMAIL ADDRESS:
Electronic copies of this form and further details can be obtained from:
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APPENDIX 2
EXERCISE REFERRAL SCHEME – Clinician Sign up Form Registered Community Physiotherapists & Exercise Physiologists employed by community or acute healthcare trusts may refer patients to the Exercise on Referral Scheme if they agree to:
retain clinical responsibly for patients while they are on the scheme
complete ALL required information on the Exercise Referral Form
be available to the exercise professional to answer queries relating to patients they have referred to the scheme
inform the patients GP via letter that they have referred a patient for exercise on referral
In addition: Healthcare professionals referring patients to the Oxfordshire Exercise on Referral scheme must be registered with the relevant professional body and have appropriate qualifications and accreditation for the role they perform. NHS employed healthcare professionals referring patients to the Exercise on Referral scheme must be professional competent to make referrals and should follow the stated terms and conditions in this document. NHS employees who meet these requirements are covered by vicarious liability.
NAME:
DEPARTMENT:
WORK ADDRESS:
TELEPHONE NO:
EMAIL ADDRESS:
Please complete, sign and return this form to the address below:
Physical Activity Team, Oxfordshire Sport and Physical Activity, C/O Community Services Directorate, Oxford City Council, Horspath Road, Oxford, OX4 2RH
I have read the “Oxfordshire Exercise on Referral: Clinicians Guide” and agree to comply with the stated referral criteria, patient enrolment process and accept clinical responsibility for the patients I refer.
Signed:
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APPENDIX 3 Liability
‘The Medical Protection Society (MPS) endorses the provision of supervised exercise sessions for patients and appreciates that the GPs have an important role in facilitating the use of exercise programmes. In order to encourage GPs to become involved in referring patients for exercise it is important that the guidelines are simple and GPs do not feel they are being asked to take on responsibilities for which they are ill equipped. It would be helpful for there to be either national or local guidelines which set out specific conditions for which referral for a structured exercise programme is appropriate.
The introduction of the exercise professional who will be registered with a national body and have indemnity in respect of his work is welcomed. We see no difficulty in GPs providing the exercise professional with details of the patients past medical history with the consent of the patient for a planned programme of exercise, the content of which would be his responsibility. It would be expected that the exercise professional would feed back to the GP any problems that are encountered and the progress that is made through the programme. With this framework we would see the GPs involvement as forming part of his responsibilities as a general practitioner and provided he was paying the appropriate subscription then he could look to the society for advice and an indemnity in respect of this part of his practice’ (Medical Protection Society, 29/3/2000) Healthcare professionals referring patients to the Exercise on Referral scheme must be registered with the relevant professional body and have appropriate qualifications and accreditation for the role they perform. All patient records should be kept in accordance with national and local protocols and policies and any transfer of patient information should be done in accordance with Caldicott regulations and comply with the NHS Confidentiality Code of Practice NHS employed healthcare professionals referring patients to the Exercise on Referral scheme must be professional competent to make referrals and should follow the stated terms and conditions in this document. NHS employees who meet these requirements are covered by vicarious liability.
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APPENDIX 4
QUALITY STANDARDS FOR EXERCISE ON REFERRAL PROVIDERS
Organisations signing up to provide exercise on referral through this scheme agree to provide evidence to their local district council, on request, that they and their employees providing the service meet or exceed the standards outlined below. Further, they agree to participate in annual peer review of their service by other providers within the scheme and disclosure of findings. Organisations providing Exercise on Referral must ensure that:
clients are assessed, managed and followed up by appropriately trained staff (minimum level III)
clients are given verbal advice about exercising safely
the organisation has a standard procedure for initial, intermediate and final assessment of clients and that all staff taking clients ‘on referral’ are adequately trained in its use
copies of client’s initial, intermediate and final assessments are given, in writing, to the client and a copy sent to their referring practitioner
a full risk assessment has been completed prior to providing the scheme
documented procedures are in place for health & safety checks in the exercise area
all electrical equipment has been PAT tested
all client sessions are adequately supervised by appropriately trained personnel (minimum level 2 although wherever possible the exercise referral trained instructor should supervise or be present during the sessions)
evidence of either company or personal liability insurance can be produced on request
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Oxfordshire Exercise on Referral Scheme Providers
Location Run by Contact Times of sessions
Inclusive Activities Available
Cost and Duration
ABINGDON: White Horse Leisure and Tennis Centre Abingdon Oxon OX14 3PJ
GLL BETTER
Post Referrals to: Claire Brokenshire, White Horse Leisure & Tennis Centre, Audlett Drive, Abingdon , Oxon, OX14 3PJ 01235 540700
Mon 9.30-11.30am pulmonary rehab. Tues 9.30-11.30 am cardiac rehab. Thurs 9.30-11.30am general EOR. All other one to one sessions by appointment
Gym Swim Classes (Creche available at extra charge) Multi Sport Sessions. Phase IV Cardiac Rehabilitation
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
ABINGDON: The Park Club 17 Croft Drive, Milton Park, Abingdon, Oxford OX14 4RP
Soll Leisure Richard Claydon / Quentin Bevan 01235 206777 [email protected]
Monday 2-4pm Wednesday 2-4pm
Gym Swimming Studio Classes (At discretion of the instructor)
Initial consultation free. £2.50 a session or £24.99 a month thereafter. £48 for 12 weeks
BANBURY: Spiceball Leisure Centre Banbury Oxon OX16 2BW
Parkwood Community Leisure
Darren Whittle 01295 257522 [email protected]
Gym Mon to Friday 6.15am to 5.00pm
Gym (Creche available at extra charge)
20 sessions @ £3.70 per session
BERINSFIELD: Abbey Sports Centre Green Furlong Berinsfield Oxon OX10 7NR
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421
healthwise.southoxfordshire&[email protected] 01865 341035
Gym Monday to Friday 7am to 10.00pm Saturday/Sunday 9am – 5.00pm
Gym Swimming
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
BICESTER; Bicester & Ploughley Queens Avenue Bicester OX26 2NR
Parkwood Community Leisure
Chris Agnew 01869 253914 [email protected]
Gym Monday & Wednesday 9am-6pm Swimming Tuesdays 1pm-2pm
Gym Swimming (Creche available at extra cost)
20 sessions @ £3.70 per session
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Location Run by Contact Times of
sessions Inclusive Activities Available
Cost and Duration
CARTERTON: Carterton Leisure Centre Broadshires Way Carterton Oxon OX18 1AA
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 [email protected]
Gym 6.30am – 10.00pm Swimming
Gym Swimming
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
CHIPPING NORTON: Chipping Norton Leisure Centre Burford Rd Chipping Norton Oxon OX7 5DY
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 [email protected]
Gym 6.30am – 10.00pm Swimming
Gym Swimming
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
DIDCOT: Didcot Wave Newlands Avenue Didcot Oxon OX11 8NX
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 healthwise.southoxfordshire&[email protected] Centre Number 01235 819888
Gym Monday to Thursday 6.30am to 10.00pm Friday 6.30am – 8.00pm Sat/Sun 6.30am – 7.00pm
Gym Swimming Specialist Cardiac Rehab
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
Continued on next page….
Location Run by Contact Times of sessions Inclusive Cost and
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Activities Available
Duration
EYNSHAM: Bartholomew Sports Centre Bartholomew School Witney Road Eynsham Oxon OX29 4AP
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 [email protected]
Gym 6.30am – 10.00pm No swimming
Gym No swimming
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
HENLEY: Henley Leisure Centre Gillotts Lane Henley-on-Thames RG9 1PA
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 healthwise.southoxfordshire&[email protected] Centre Number 01491 577909
Gym Specialist Cardiac Rehab Thursday’s 1 – 2.30PM
Gym Swimming
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
FARINGDON: Faringdon Leisure Centre, Fernham Road, Faringdon, Oxon, SN7 7LB
GLL BETTER
Contact Healthwise Coordinator: 01367 241755 healthwise.southoxfordshire&[email protected]
Monday 5pm-7pm Wednesday 9am-11am
Gym Swimming Studio Classes (At discretion of instructor)
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
KIDLINGTON: Kidlington & Gosford Sports Centre Oxford Rd Kidlington OX5 2NU
Parkwood Community Leisure
Tristan Clarke 01865 376368 [email protected]
Tuesday & Thursday 9-5.30pm
Gym
20 sessions @ £3.70 per session
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OXFORD - SUMMERTOWN Ferry Sports Centre Diamond Place Summertown Oxford OX2 7DP
Fusion
Danny Kavanagh 01865 467067 [email protected]
Aspires Fitness Suite Normal opening hours
Aspires Fitness Suite Swimming
Initial price £5.60 £1.20 per session
OXFORD CITY: Leys Pools & Leisure Centre Pegasus Rd Oxford Ox46JL
Fusion
Centre Number 0844 8933 222
Aspires Fitness Suite Normal opening hours
Aspires Fitness Suite
Initial price £5.60 £1.20 per session
OXFORD CITY: Barton Leisure Centre Waynflete Rd Oxford OX3 8GA
Fusion Centre Number 0844 8933 222
Aspires Fitness Suite Normal opening hours
Aspire Fitness Suite Swimming
Initial price £5.60 £1.20 per session
THAME: Thame Leisure Centre Oxford Road Thame Oxon OX9 2BB
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 healthwise.southoxfordshire&[email protected] Centre Number 01844 215607
Gym Monday to Friday 7am - 10.00pm Saturday 8.00- 6.00pm Sunday 9am – 6.00pm
Gym Swimming Specialist Cardiac Rehab Thursday’s 10 – 11.30AM
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
WANTAGE: Wantage Leisure Centre, Portway, Wantage, Oxon OX12 9BY
GLL BETTER
Contact Healthwise Coordinator: 01235 766201 Centre Number 01235 766201
Tuesday 08:30-09:30 and 11:30-12:30 Thursday 08:30-09:30 and 12:00-13:00
Gym Swimming Studio classes (At discretion of Instructor) Phase IV Cardiac Rehab
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
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WITNEY: Windrush Leisure Centre Witan Way Witney Oxon OX28 4YA
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 [email protected]
6.30am – 10.00pm Studio Sessions As programme Swimming
Gym Studio Sessions Swimming Specialist Cardiac & Pulmonary rehab
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
WHEATLEY: Park Sports Centre Wheatley Park School Holton Oxon OX33 1QZ
GLL BETTER
Debbie Cameron Healthwise Coordinator 07825 670421 healthwise.southoxfordshire&[email protected] Centre Number 01865 872128
Gym Mon/Wed/ Fri 8.45am - 10.00pm Tuesday/Thursday 7.00am - 10.00pm Saturday/Sunday 9.00am – 6.00pm
Gym
Better Health £3.00 Pay and Play £20.00 per month Direct Debit
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