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NICE: GPs should screen all adults for exercise habits

GPs and practice nurses should screen all adults to determine if they reach recommended levels of physical activity, recommends draft guidance published by NICE.

The guidance says practices should opportunistically use questionnaires to determine the activity of all their adult patients in consultations and tailor advice to those who are not sufficiently active including identifying motivational issues.

The guidance also said physically active patients should also be advised to maintain their habits, and recommends that QOF indicators are developed to ‘raise the profile of physical activity’ among GPs.

The radical proposal published this month are designed to make enquiries about physical activity ‘more routinely’ incorporated into daily practice, and supports the ‘making every contact count’ philosophy enshrined in the NHS Mandate published earlier this year.

The guidance says: ‘For people who are assessed as being inactive, identify the most appropriate time to discuss physical activity. This might be in the current consultation or in a later consultation, and might involve referral to another member of the primary care team.

‘If it is in a later consultation, make sure it occurs at the earliest opportunity and ensure that the person, at the minimum, leaves the initial session aware of the health benefits of activity.’

‘The guidance adds: ‘Specific QOF indicators for physical activity advice would be likely to encourage GPs to increase the assessment of people’s physical activity and the delivery of brief advice in primary care.’

The guidance updates previous advice from NICE published in 2006 to offer ‘brief advice’ to patients on how to improve their levels of physical activity. It recommends GPs use a validated tool – such as the general practice physical activity questionnaire - to assess patients and record the outcome in their records. It also recommends GPs consider a written prescription for exercise.

It also suggested that to facilitate brief advice, GPs could use scheduled health checks, checks of disease registers, long-term disease management plans,  ‘triggers’ in computerised patient records, and incentive schemes.

Current guidelines from the Chief Medical Officer on physical activity says everyone aged 19 or over should take either 30 minutes of moderate exercise at least five days a week, or 75 minutes of vigorous exercise each week while also exercising to improve muscle strength at least twice a week.

By ‘brief advice’, NICE means verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. It can vary from basic advice to a more extended, individually focused discussion.

The draft guideline is out for consultation until 23 January 2013 and the comments will be reviewed by NICE in February.

Commenting on proposals, GPC deputy chair Dr Richard Vautrey, a GP in Leeds, said: ‘Whilst GPs already take appropriate opportunities to encourage exercise to do this for every patient, whether wanted by the patient or not, is yet another thing to try and fit in to already packed consultations.

‘GPs and practices are trying to cope with dangerous levels of workload. They cannot do more without additional resource to employ more staff. The reality is the Government’s proposed contract imposition could see practices cutting staff rather than employing more.’

What GPs are being asked to do

-          Screen all adults to ensure they take the recommended level or exercise, opportunistically in consultation or waiting rooms, and in pre-planned consultations for managing long term conditions

-          GPs should tailor ‘brief advice’ to each patient, after identifying motivational factors…

-          To all patients who are assessed as being inactive…

-          As well as those who are physically active, to ensure they keep it up

Source: NICE