How should we use
By Nerys Hairon
GPs are shunning exercise referral schemes because of scepticism over their effectiveness and concerns over legal liability.
Two new studies exposed GPs' resistance to exercise referral as news emerged of the death of a middle-aged woman on a scheme in Cardiff.
The first study found GPs and their practice staff referred only 4 per cent of sedentary adults over a five-year period with no increase over time.
The study of 125 GPs in Wigan and 6,610 of their patients, published online by the Journal of Public Health, found a small minority of GPs were responsible for the vast majority of referrals. Some 17 per cent referred between 100 and 450 patients over the five-year period, whereas 42 per cent referred just one to 10 patients.
Study leader Dr Roger Harrison, a senior research fellow at Bolton PCT and the evidence for population health unit at the University of Manchester, said: 'There was doubt about benefit. I think some have concerns about why this should be funded out of an NHS budget.'
A second study, to be published in the Journal of Ergonomics, found GPs were reluctant to refer patients because of lack of evidence, concerns over med-icolegal responsibility, time constraints and lack of knowledge (see box, right).
The survey of 71 GPs and practice nurses in the North-West followed by 11 in-depth interviews concluded: 'Government support and funding may be needed to increase some health professionals' endorsement of physical activity promotion.'
Study researcher Dr Lindsey Dugdill, a reader in exercise and health at the University of Salford, said: 'GPs' own confidence and competence is an
issue. The second issue is about the medicolegal aspects whose responsibility is it?
'I think GPs are sceptical and they have a right to be because the evidence base is very poor.'
The legal concerns were reinforced after 46-year-old Elizabeth Kavanagh died after being taken ill at a supervised gym session following GP referral.
Dr Peter Schütte, head of advisory services at the Medical Defence Union, said: 'The referrals should be to schemes where the exercise professional is properly registered.
'Most GPs they are not qualified in sports medicine. They are not really in a position to say patients are fit for exercise in many cases. The best advice for the GP when referring is to change the wording to "I know of no reason why this patient should not be fit for exercise''.'