LEGAL IMPLICATIONS

The course covers the background of each disease instructors might encounter, the drugs patients may be taking and how they could affect exercise tolerance.

‘Once GPs can see that a course is respon- sible and adapted for their patient they will be happier about referring.’

Nicky Timmins, a fitness manager at the Dorset Racquets club, says before Dr Brewer’s scheme they were dabbling. ‘Someone would come in with diabetes and get different advice from different instructors. Now instructors are enthusias- tic because they know they have support and back up’.

The Medical Protection Society’s head of legal services Dr Albert Day welcomes such training schemes and the NVQs as a ‘good indication that the fitness profes- sion is taking this seriously’.

‘It will help GPs to know that they are rec- ommending a reputable organisation with properly trained people.’

But he still cautions that doctors are expected to give ‘reasonable advice’ to patients. For exercise referral this should involve taking a thorough history and examination, with investigations such as ECGs where appropriate.

Unfortunately, he admits the MPS is ‘not talking with any of the sports organisa- tions at the moment. They haven’t approached us and we wouldn’t approach them unless they asked.’

Neither is the MDU swayed by the NVQs. Medico-legal adviser Dr Nicholas Norvell says: ‘It is still the doctor’s responsibility for what they do and it is inappropriate to prescribe something they know nothing about.’

Whatever their reservations about the concept of exercise prescription the MDU does approve of the quality assurance framework and hopes it will ‘facilitate dis- cussions’ with the BMA, Department of Health and exercise professionals to draw up guidelines to make the doctors’ role clearer.

Possible ways forward As it currently stands the advice from the Medical Defence Union is that docotrs

24 SportEX

should use the skills they have to make their own evaluations in each case but then rather than ‘prescribing’ exercise they should perhaps ‘recommend’ it.

Dr Schutte adds that describing the process as ‘referral’ is preferable, but any referral must be to someone registered with a statutory body such as a chartered physiotherapist.

Dr Brewer says: ‘People do raise legal issues with us, but I think it is irrespon- sible not to offer the benefits of exercise.’

His scheme, which was developed with Bristol University, requests that GPs refer- ring patients for exercise fill in necessary patient details on a form which offers a welcome session for a controlled exercise test. The test is designed to establish safe levels of cardiovascular activity, with checks for heart rate and blood pressure. This is carried out before individual pro- grammes are designed.

‘Any high-risk patients, suffering from conditions such as recent MI, have an individual consultation with me’.

Another potential solution includes set- ting up sessions in which GPs can refer potential exercise scheme patients to a

specialist ECG unit probably based in a hospital for a full exercise test to estab- lish safe cardiovascular activity levels before embarking on an exercise scheme. There is no reason why this sort of unit could not be established within a local GP surgery or even gym as long as it is run by a properly qualified medical practitioner.

As yet there is no case law in this area because no cases have been brought to court however few people in either the medical or the fitness profession would deny the need for guidelines which would hopefully have a risk/benefit approach as part of the decision-making process.

If the government is to continue promot- ing regular exercise and more specifically exercise prescription-type schemes with doctors involved there has never been a greater need for official advice and guide- lines.

Further references ● On the SportEX Medicine website there

is a customisable GP referral form with a set of field suggestions based on various examples of best practice. See under the Health Promotion section of the site. ● The National Quality Assurance Framework will be available from the Department of Health later in the year.