Physical inactivity has been described as an epidemic and one of the greatest public health challenges of our times. The World Health Organisation now states that it is the fourth largest cause of premature death across the globe and a new All-Party Parliamentary Commission has been set up to look into how it can be addressed.
From my perspective, whenever this topic rears its head in the press, it doesn’t feel good to find GPs branded so negatively, as has been the case lately.
According to recent reports, doctors are ‘turning us into a nation of pill-poppers’ and we’re ‘too quick to prescribe medications’ instead of exercise. But Macmillan has published a report claiming that GPs could save up to 37,000 people by getting them moving, and a new report commissioned by Nuffield Health pointed out that doctors are nearly 50 times more likely to prescribe medication for depression and other mental illnesses, instead of other proven alternatives such as exercise.
Critics and commentators ask, is the under-prescription of exercise because doctors don’t care or are ignoring the evidence?
Of course not. For example, in the case of mild and moderate depression it was found by the Mental Health Foundation in their report Moving On Up that 56% of GPs felt a supervised programme of exercise would be ‘quite effective’, while 5% believed it to be ‘very effective’.
So why aren’t more GPs prescribing it? In my view, the problem for GPs is the usual calculation of lack of time plus lack of access. In the same survey it was found that 42% of GPs surveyed do not have access to a scheme in which they can refer patients for support to get active.
Of those GPs who did not have access to such a scheme, 95% said that if they did they would use it as a treatment for mild to moderate depression. Some 15% said they would use it ‘very frequently’ and 51% said they would use it ‘fairly frequently’.
The desire is largely there – what is missing is the joint working between exercise professionals and GPs.
And, despite racking up a grand total of four hours on the benefits of physical activity during our training courses at medical school, my colleagues are increasingly better read on the topic, helped by the constant barrage of evidence in the press. And yet exercise is still under-prescribed.
Ways to get patients moving
There is clearly something structural that is the problem and many of these issues were highlighted in the ground-breaking Royal College of Physicians report Exercise for Life.1 Some GPs, including myself, are turning to interventions such as ukactive’s Let’s Get Moving programme. Based on NICE guidance on brief interventions, it provides us with advice on initiating exercise and use proven motivational interviewing techniques.
We have to accept that as GPs we are very time constrained. And, despite our gilded education, it’s rare that you’ll find a GP in a position to offer a high standard of physical activity advice or perhaps even comfortable doing so.
The solutions are to be found in strong links and practical pathways to provide personal support toward better physical activity. We need to bring this as close to our surgeries as possible, into the heart of our practice teams.
The Let’s Get Moving model recommends GPs place an exercise professional in their surgery to provide advice and guidance. Where we are sending patients off for exercise on referral services, we need to ensure that they are of a high quality and deliver the measurable outcomes that justify their existence.
Clearly the desire is there from GPs to play their part, and organisations such as ukactive and the Royal College of Physicians show it can be done – and done well. If their programme and report recommendations were to be rolled out widely across the country then we would see a dramatic reduction in serious disease and a drop in the number of unnecessary prescriptions, saving both time and money.
But perhaps the next questions is: who should be responsible for commissioning such services in this new brave world in which we live? Local authorities, responsible for preventing ill-health, or the CCGs responsible for treating it? There may be a whole other comment article in that one day.
Dr Miranda Roberts is a clinical lead for West Essex CCG and a GP in Harlow.
1 Royal College of Physicians. Exercise for life. June 2012