Edinburgh Napier University

  Exercise on referral schemes (ERS) allow health professionals to encourage physical activity (PA) for patients with long‐term conditions. One such scheme is the Northumberland ERS, a 24‐week community‐based supervised PA intervention of primary care referrals to county leisure facilities. Since 2009, data has been routinely collected for demographics, attendance, self‐reported PA, and health outcomes (e.g., blood pressure, well‐being).  External evaluation with academic partners has provided in‐depth understanding of who is most likely to engage with and complete the scheme, along with evidence of scheme impact on PA and weight change. Qualitative research has complemented this, providing insight into the expectations and experiences of individual referees.

Whilst the scheme overall demonstrated efficacy, there were significant differences in leisure site performance, significantly increased PA but still short of government recommendations, weight loss expectations were not always met, and there was a lack of pre scheme information, particularly about cost, presenting a barrier for some. Changes have been implemented based on these findings, including a staffing restructure to reflect practice at the most successful site, enhanced staff training at poorer performing sites, and enhancing training regarding lifestyle PA to promote 150 minutes of PA/week. Scheme administrators now take a different approach to information‐giving at first contact with referrals and a concessionary price has been implemented for those on identified benefits.  Finally, an evidence‐based pilot weight management programme has been commissioned for targeted referrals.

Most recent analyses show improvements in performance by the poorest performing site, with an increase in completion from 17.4% to 34.3% (overall completion 43%) and an increase in mean PA at six months, from 81 to 101 minutes. Other changes will continue to be evaluated; however this early information demonstrates the impact of evidence‐based change within public health commissioning and is continuing to shape and enhance Northumberland County Council’s service provision.