Let's get physical

Obesity is a major cause for concern when it comes to health and related diseases. Smart, collaborative primary care is one way to tackle it. West Essex has started a three-way partnership programme to get its population moving

Let’s Get Moving (LGM) focuses exclusively on people who are physically inactive and supports them to become healthier. Participants meet one-to-one with a locally recruited community exercise professional, trained in motivational interviewing, within their GP surgery for up to 12 weeks. From community activities, to peer-led group sessions, participants are able to access all of the support and resources they may need to lead a healthier lifestyle. Delivering LGM in GP surgeries yields unprecedented results with participants, proactively recruited, becoming 79% more active.
Originally created and tested by the Department of Health and recommended by the National Institute for Health and Care Excellence (NICE), it has been developed by ukactive over the past four years with the support from a range of partners including Sport England.
The programme is already running in Birmingham, Luton, Bedford, Central Bedfordshire and Essex. Twenty-eight GP surgeries have already hosted the service with more than 20,000 people reached to date. In recognition of its potential and to be replicated and scaled up nationwide,
the programme has received further funding for its extension from leading social innovation charity Nesta and the Cabinet Office.
In October 2014 Active Essex became the physical activity commissioner for Essex County Council (ECC) public health team. As the commissioner for physical activity, Active Essex is the project lead for Let’s Get Moving. Active Essex contract manages the project with support from Essex County Council Public Health team.
Essex County Council and West Essex Clinical Commissioning Group (CCG) are collaborating on a number of commissioning projects in order to ensure better integration with health and social care. The Let’s Get Moving project is a great example of how service commissioners can work with primary care in order to deliver better outcomes for patients, with support from the CCG.
The CCG has joined up with ECC and three GP practices in the area to embed the project in their services and has also invited the local authority’s public health teams to regular GP membership meetings. This has helped enhance integration and shown to be useful to promote uptake of the service.
The LGM programme is based on the national LGM pilot of promoting physical activity in primary care, which showed evidence of effectiveness in increasing physical activity through GP-led consultations in GP practices.
The Essex model enhances the national pilot programme by delivering structured behavioural counselling using community exercise practitioners (CEPs) trained in brief, structured and motivational interviewing. It is based on a model previously delivered in Essex in 2010-11.
Active Essex became involved in Let’s Get Moving because the project offers promotion of physical activity in GP practices across Essex. It uses a targeted approach to clients who would most benefit from being more physically active.
The intervention is confined to promotion of physical activity rather than wider issues of healthy lifestyle, but community exercise professionals will signpost clients to other locally commissioned services in Essex for help in areas such as smoking cessation.

Patients’ gain
A key aspect of this project is that clients are supported to work through their own attitudes and issues to being more physically active, and arrive at their own conclusions about their readiness, motivation and confidence to be more physically active. This is achieved through a behavioural counselling approach where the client is directed, in a subtle way, to reach their own conclusions and generate their own action plan. This is a key aspect to successful adherence to physical activity programmes.
If, through the behavioural intervention, clients make a decision to explore options for local physical activity, the community exercise professionals will make an informed decision about when and how to share information on local physical activity options available through the umbrella of Active Essex, the County Sports and Physical Activity Partnership.
Specially trained exercise professionals work in the heart of GP surgeries to inspire change in communities and re-embed movement, physical activity and sport into the lives of inactive populations through proven motivational interviewing techniques.

Patient outcomes in other UK areas
Patients demonstrate an increase in physical activity against baseline self-report measure at first follow up appointment and sustained at six months appointment.
The ukactive Research Institute has observed the following uplifts in activity from patients completing the 12-week interventions:

Vigorous activity increased by 100%.
Moderate activity increased by 53%.
Walking increased by 78%.
Total physical activity increased by 79%.
Additionally, health checks were made available to LGM patients at a surgery in Bedfordshire. It was observed that during the 12-week intervention:
Systolic blood pressure reduced by an average of seven millimeters of mercury (mmHg).
Body fat percentage reduced by an average of 5.13%.
Body fat mass reduced by an average
of 4.96%.
Lean mass increased by an average of 5.65%.

Progress in Essex so far
The service is already live at three Essex surgeries:

Addison House Surgery, Harlow.
Kings Medical Centre, Buckhurst Hill.
Lister Medical Centre, Harlow.

These surgeries have had 180 patients access the Let’s Get Moving service.
The ageing population and increased prevalence of chronic diseases requires a shift in commissioning priorities, from reactive, acute, and episodic care towards prevention, behaviour change and self-care. Having delivered LGM in several local authorities, ukactive has already overcome significant commissioning barriers to develop a responsive model that is scalable, accessible, well-coordinated and integrated.
The activity levels of our patients significantly increase through the programme; this not only attends to patients’ priorities by reducing their chances of serious illness or premature death, but enhances their quality of life. Such outcomes have a profound social and economic value and contribute to the overall sustainability of the sector. From signposting to community activities, to group sessions based on the social action model, where a community is empowered and motivated to take action for a common good at a grass roots level (funded by Nesta), social prescribing is embedded within our LGM model. Research shows social prescribing delivers time and cost savings while facilitating enhanced outcomes such as reduced social isolation, bringing real innovation into the commissioning process.
Furthermore, LGM’s person-centred approach and use of motivational interviewing, empowers our patients to make their own informed choices about changing their behaviour.
Patients who feel involved in their care make better decisions, and our LGM model ensures initiatives such as exercise referral or publically funded health initiatives can be allocated more efficiently.
In this climate of reducing budgets and increasing demands in the NHS, our LGM model will lead to a more appropriate use of health care professionals’ time and reduce the number of referrals into the acute sector or more costly interventions, while using locally available assets and the power of peer to peer behaviour change.
Initial patient outcomes from Let’s Get Moving demonstrate that the three-way partnerships are already proving successful and that they will lead to new opportunities in the future.

West Essex CCG
Clare Morris, chief officer at NHS West Essex CCG gave her view:
“The Let’s Get Moving project is the ideal way to support people to live healthy and active lifestyles. This is an integral part of efforts in local health and care towards early intervention and prevention wherever possible.
“We now work closer than ever before with Essex County Council to recognise and cater for local need in a way that allows people to really take control of their own wellbeing.
“Having access to the right services closer to home is a key theme throughout our engagement with local people so having GP surgeries at the centre of this project provides people with the right support on their doorstep.
“Positive effects on people’s lives are already shining through so we’re excited by the future potential of this project and its model of delivery. l

Jason Fergus, director of Active Essex.