Encouraging and supporting patients with LTC’s to be more physically active: Qualitative research
Summary of findings
· Exploring and examining the issues involved in the promotion of physical activity is a particularly broad and complex area
· Physical activity’ is an area that is seemingly lacking in clear definitions and parameters at a number of different levels
· It seemed unclear as to exactly what ‘promoting’ or ‘supporting’ physical activity actually meant
· Respondents seemed to see physical activity, conceptually, as an integral part of health care for all patients but, in practice, it was not
· Respondents, especially those working in general practice clearly tended to associate physical activity with those who were deemed as being ‘overweight’
· There was debate as to whether increasing physical activity should be seen as part of health promotion generally or whether it should be treated separately, similar to alcohol or smoking
· It was clear that it was simply not the case that the majority of GPs or other healthcare professionals did not promote or encourage physical activity. At one level, it clearly depended on whether physical activity was a particular interest of a GP. At another level, it was possible to segment respondents into those who were ‘proactive’ and those who were far more ‘reactive’ and who merely either responded to patient demands for exercise or who felt that it was a high priority for that particular case – for example in cardiac rehabilitation
· A further segmentation was between those who talked about referrals to a particular activity or programme and those who appeared to see it more ‘holistically’ believing that it should be part of life more generally, thus encouraging patients to build up their activity in their day-to-day lives
· It was clear that the majority of those interviewed ‘believed’ in physical exercise but it seemed evident that this should be distinguished from the integration of it into their daily consultations
· The evidence also showed that there was a seeming lack of co-ordination in the system to support patients to increase their physical activity at a number of different levels
· It seemed the problem was not simply a lack of co-ordination but equally a lack of follow-through. For example, patients were referred to programmes but this did not tend to be followed up and GPs or other health care professionals rarely received feedback
· Feedback was seen by many as being important as a motivator in the promotion of physical activity for both patients as well as GPs
· It seemed apparent that many GPs, in spite of clearly believing that physical activity was part of their remit and role, also thought that by simply referring their ‘job was done’
· At a national level, it appeared that there was a vacuum in terms who ‘owned’ the agenda for physical activity at a local and at a more strategic level (i.e. whether ‘physical activity’ should be under the remit of Public Health or Clinical Commissioning Groups)
· There was debate as to whether it was a question of enough programmes available or simply the right programme for the specific long term condition. But more commonplace was an acknowledgement on the part of many health professionals that they simply did not know what existed in their area. The general consensus was that GPs and practices needed to be told repeatedly about new programmes
· Most thought that a variety of media, especially emails, sent both directly to GPs and/or via the practice manager were a good form of contact but there was an almost unanimous call for face-to-face contact in order to motivate GPs to promote and encourage physical activity
· Respondents called for educational talks firstly to ‘educate’ healthcare staff about exercise and its benefits, citing case studies for example and secondly to provide information about activities generally as well as locally. Whereas some believed that physical exercise specialists or even consultants should deliver these talks, others felt that GPs would respond more positively to a colleague
· Some felt that the introduction of CCGs, would be an ideal time to put it once again on the agenda but the majority believed that this was unlikely, given the financial constraints and presently there was too much upheaval within the NHS
· Some felt that by inserting it into more care pathways and on disease templates similar to smoking and drinking, it would ensure that it would become higher on the agenda
· It seemed it would be more appropriate to work towards a clearer understanding of what was meant by ‘physical activity’ by whom and for whom and how an uptake of physical activity might benefit both patients and GPs
More generally, the research study found that;
· The views of Directors of Public Health and commissioners did not differ substantially from those of GPs, nurses and healthcare assistants
· GPs, unlike those either based in PCTs or at a national level, were not simply reluctant to be interviewed but it was difficult at times to engage them fully in conversation
NHS London commissioned this research in order to develop an understanding what they can offer health professionals in exchange for supporting their patients, in terms of personal information and advice, to become more active and how NHS London can make it easier and quicker for them to do so effectively.
Specifically the research was commissioned to;
· Explore what support and systems need to be in place in the local health economy to support health professionals to promote and encourage, both proactively and appropriately, active lifestyles among those with long term conditions
· An overview of pan London activity using new and existing data
· An understanding of what will move, motivate and enable GP practice staff to encourage and support their patients, both proactively and appropriately, to engage in realistic activity
· An understanding of the capacity needs of practice staff, so that self reliance and sustainability could be built in
The outputs from this research will be used to inform the pan London programme that will leverage the 2012 Olympic and Paralympic Games and the national campaign to emphasise and ensure a lasting legacy for improving physical activity among the target audience.
Promoting healthy lifestyles has been at the forefront of Department of Health and NHS thinking for some time now. Whilst much has been achieved through the provision of health, well-being and fitness programmes and by targeting action on health inequality, there still remains a great deal of variability across the country and within London it is thought that there is a good deal more that could be done.
As part of the drive to promote and support physical activity, NHS London in partnership with GaxoSmithKilne (GSK) are designing a national communications campaign, ‘Your Personal Best’ that will aim to inspire and encourage people with long term conditions (PLTCs) to undertake more physical activity, breaking down the barriers and driving behavioural change, enabling them to achieve their ‘personal best’. This campaign is set against the context of the London Olympic and Paralympic Games which are considered to be an unique opportunity to create a long-term legacy which includes making the UK a leading sporting nation and inspiring a new generation to take part in physical activity. Of particular concern is the opportunity to inspire those with LTCs to engage with this agenda.
Long Term Conditions (LTCs) are defined by the World Health Organisation (WHO) as health problems that require ongoing management over a period of years or decades. They include a wide range of health conditions and cover both non-communicable and communicable diseases, some mental health conditions and on- going disabling conditions.
The Department of Health estimates that the treatment and care of people with LTCs account for 70% of the total health and social care spend in England and amounts to £7 in every £10 spent. It is suggested that self management of LTCs will reduce GP visits by between 24% and 69% and hospitalisation by 50%. There is, therefore, an increasing impetus driven by the evidence for health care professionals to be able to empower power people with LTCs to take an active role in managing their conditions by providing them with the confidence, skills and information to enable them to take greater control over their health.
There is an overwhelming evidence that exercise can bring tangible benefits to people with LTCs. Regular activity has been shown to have both preventative and therapeutic effects on many contemporary chronic conditions such as CVD, cancer, musculoskeletal disorders, obesity, diabetes and mental illness.
Research commissioned by GlaxoSmithKline (GSK) found that, in line with previous research, GPs, nurses and pharmacists believe that those with LTCs would benefit both psychologically and physically from increased levels of physical activity. The research also indicated the importance of the role of the GP in promoting physical activity among the target population but suggests that there are enormous pressures on GP time (and this is particularly the case at the present time with the impending NHS structural changes) and as a result the impact of GP involvement in supporting physical activity is variable.
As a result, NHS London commissioned primary research to inform the development of a local response across London to a national campaign to increase physical activity among over 55s with LTCs.
There is an overwhelming body of evidence that increased physical activity can deliver tangible health benefits (both psychological and physical) to patients suffering with a Long Term Conditions. NHS London commissioned this research to inform the development of a local response across London to a national campaign to increase physical activity among over 55s with LTCs.
Included, in-depth individual interviews and group discussion were held with a wide array of health professions, including directors and leads, across NHS London, the Department of Health who are directly involved in this topic area.
Included, in-depth interviews with key Public Health staff across the 3 identified London boroughs examined for this research.
Included, in-depth individual interviews and group discussions were held with key staff involved in the delivery of care to patients across the three identified boroughs.
Stage one -10 x Key senior health professionals
Stage two - 12 x Key health professionals working in Public Health departments at a PCT level
21 x GP’s
11 x Practice Nurses and or Health care Assistants
3 x Health Trainers
2 x Practices Managers