Shared learning database

 
Organisation:
NHS London
Published date:
January 2013

My Best Move is a project initiated and sponsored by NHS London and delivered by Intelligent Health, to increase physical activity in patients with long term conditions. It is one of the key 2012 Olympic Games health legacies of NHS London. The focus of the project was on training GPs and other health professionals to deliver physical activity interventions that were appropriate and relevant for these patient groups, with a focus on walking and 'everyday' physical activity.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
No
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Yes

Example

Aims and objectives

My Best Move aimed to train GPs to prescribe physical activity to patients with long term conditions. It was designed to align with existing primary care physical activity promotion interventions (e.g. Let's Get Moving) to inspire an increase in activity levels among patients with those conditions. The project aimed to train GPs and healthcare professionals from across 33 Boroughs in London with a target of delivering the training to at least two GP practices in each borough. My Best Move was scheduled to run during 2012 to build on the buzz generated by the London 2012 Games.

The overarching aim was to heighten GP's knowledge of the potential benefits of physical activity and to build their confidence in recommending it as part of their patients' treatment. A secondary aim was to providea demonstrated model that could be presented by NHS London to London Health and Wellbeing Boards, Clinical Commissioning Groups and other decision makers with a role in health improvement.

My Best Move also aimed to produce a comprehensive toolkit to assist GPs in understanding the benefits and contraindications of activities for their patients. This took the form of a GP Guidance booklet with over 300 clinical references, edited by a team of experts in the field of physical activity and sports and exercise medicine. The booklet can be adapted and tailored to include information about local activity opportunities.

Reasons for implementing your project

My Best Move was developed using findings from combined sources, in particular results from an NHS London social marketing study involving Kingston, Newham and Enfield GPs. The study indicated that some previous physical activity initiatives had attempted to embed physical activity in primary care with limited success. The project was designed to bridge challenges that implementation of 'Let's Get Moving' has faced. The study highlighted that: many GPs don't see the promotion of physical activity as their role; the pathway was seen to be bulky and difficult to implement in primary care; delivery in-house relied on staff taking a motivational interview course.

Development was informed by an NHS London Long Term Conditions Steering Group, consisting of experts in sport and exercise medicine, physical activity programmes and public health policy. Feedback from ten training sessions helped to refine the approach. This process established that physical activity is usually promoted with weight loss interventions, and that knowledge levels were generally low amongst GPs and healthcare staff. A growing body of evidence is showing the therapeutic effect of exercise on conditions as diverse as asthma, depression, back pain and certain cancers. Recently evidence has been robust enough to compete against evidence for pharmaceutical interventions. By shifting the focus of training to how physical activity can help treat many conditions, GPs could appreciate how recommending physical activity could lead to better patient outcomes and is relevant to their role. Physical inactivity has suffered from being synonymous with obesity and many staff felt uncomfortable discussing weight with patients or felt that patients lost motivation for exercise as, without dietary changes, it did not lead to significant loss of weight. Recent studies show the relative importance of cardio respiratory fitness for overall risk of mortality. Low cardio-respiratory fitness contributes more to mortality than obesity and is independent of obesity. This evidence was new to nearly all GPs trained and many staff felt encouraged about discussing physical activity and all its benefits with patients without necessarily having to discuss the sensitive issue of weight. Feedback from the ten 'pilot' training sessions also revealed that no GP's knew how to apply the current Government guidelines for physical activity.

How did you implement the project

'My Best Move' puts into practice Recommendation 6 of PH41 for Clinical Commissioning Groups and uses an accepted theoretical framework for behaviour change. As the research findings highlighted the difficulties implementing Motivational Interviewing (MI) clinics, we adapted the training to include a brief introduction to MI theory and concepts, adopting a pragmatic approach to what could be done with a patient in the short time of GP consultations. Where possible, fuller MI was still encouraged, especially for hard to reach patients, but the new training highlighted the role that GPs can play in the behaviour change process, even if to only to start that process.

In an adapted MI technique staff were introduced the concepts of goal-setting and solution-based counselling. By working with GPs and focusing on Long Term Conditions, the project ensures groups likely to be the least active are encouraged to participate. There is a perception amongst many staff and the public that physical activity needs to consist of structured exercise to be effective. In line with Recommendation 7 (PH41) the training emphasised how everyday activities, especially walking and cycling, can impact on health. Once this point had been recognised by GPs, many were keen to see how they could act to encourage more activity in their populations and were keen to highlight deficiencies in the locality which led to low levels of activity and play. The training harnessed this enthusiasm for change and part of the session was spent on making links with e.g. local sustainable travel organisations, local health walks providers and identifying, using local maps, other opportunities for cycling and walking.

The GP practices were also keen to adapt their own behaviour to include more activity by e.g. challenges for practice staff to walk to work, join a local health walk or, at the least (in line with guidance on reducing sedentary behaviour) walk to the waiting room to call in patients rather than use tannoy systems. The project showed that the relationship between local providers of activities and the practices was often non-existent. To overcome this we invited local providers of walking and cycling initiatives to the training sessions to introduce them to the GPs who would be sending patients to them. Many GPs asked for leaflets and maps to be provided for the surgeries for patient use and, working with leisure and travel staff, we were able to facilitate this.

Key findings

'My Best Move' was designed as a pilot project to test the feasibility of engaging GPs to adopt physical activity interventions for their patients with long-term conditions. Between January and July 2012, training was delivered by Intelligent Health to 67 GP Practices across 29 London Boroughs. A total of 314 practice staff have been trained, of these 167 are GPs or Lead GPs and 70 are Healthcare Assistants and nurses. In addition 26 people from health promotion and 48 administration staff attended sessions.It was not designed to measure patient outcomes at this stage.

The project did monitor the impact of the training on GPs' knowledge and confidence in recommending activity to their patients and showed a significant improvement in both the importance that GPs and healthcare staff attached to the role of physical activity and also to their confidence in speaking to their patients about becoming more active.

A key element of the training course looked at the potential cost-savings of using physical activity rather than pharmaceutical interventions - a point which GPs were keen to share with their commissioning colleagues. Feedback collected at the end of the training sessions showed that there was an enthusiasm and real interest in this subject from GPs and other practice staff. Future phases of the roll out of 'My Best Move' will include more in depth evaluation components and look at how patient outcomes might be measured. A brief case study of two practices who took part in 'My Best Move' in Newham showed that following the GP training, referrals to motivational interviewing clinics increased by 150% from 53 patients to 130 patients over a three month period. Detail on these case studies are contained in the 'My Best Move' project report and the NHS London Go London 2012 Games Legacy Directories.

Key learning points

- Initial engagement of GPs is best done by seeking endorsement from the CCG Board.
- The training is best delivered to the whole practice, at the practice premises, during a lunchtime session. Booking training needs to be done well in advance - sometimes up to two months.
- Training should not exceed 90 minutes in duration and needs to be flexible to adapt to GPs' available time.
- The content of the training should be based around science of PA and the long term conditions that PA can both treat and prevent.
- RCN Accreditation of the training led to greater buy-in from staff who could count it as Continuing Professional Development.
- It is important to research local strategic priorities and fit and to have local information and, ideally, local providers, available at the training sessions.
- There is a need for public health to be more nimble and responsive to the needs of primary care. This might be achieved through either more focus and emphasis on patient treatment and/or through additional training. 'My Best Move' training sessions proved to be a useful opportunity to explore new ways for public health and GPs to work together more closely.

Contact details

Name:
Lily Makurah / Veronica Reynolds
Job:
Health Improvement Legacy Manager
Organisation:
NHS London
Email:
lily.makurah@nhs.net

Sector:
Primary care
Is the example industry-sponsored in any way?
No