LEGAL IMPLICATIONS

en by the main body of GPs or whether it is only undertaken by those with a partic- ular skill in this area ie. sport and exercise medicine.

The second issue is whether before pre- scribing exercise the doctor had consid- ered the relative risks and benefits of the prescription for that particular patient.

But with up to 400 different exercise referral schemes currently running throughout the UK and more springing up daily, reassurance is urgently needed if doctors are to continue to take part.

Positive changes to the exercise industry The exercise industry is doing their bit to try and improve the situation. Several dif- ferent national exercise bodies are work- ing on projects to improve the quality of instruction and protect GPs who refer their patients.

The national body for fitness, Exercise England, is leading the programme of change as part of a project group design- ing a national quality assurance frame- work for exercise referral. The framework was, at the time of going to press, on public health minister Tessa Jowell’s desk. Exercise England chief executive Dr Andrew Craig hopes it will ‘inform’ the sports strategy but agrees with the defence unions that the word ‘prescrip- tion’ is best avoided.

The document, drawn up with the British Association for Sport and Exercise Sciences, proposes ‘structured and super- vised’ activity. Specific referrals would be made for a stated reason to a named leisure centre or gym.

‘Suitably trained

and qualified’ instructors would diagnose and prescribe the type of activity for each individual ‘not someone who leads an aer- obics class in a church hall’, Dr Craig says.

The framework will encourage GPs, nurses, leisure managers, instructors and commis- sioners in health authorities or primary care groups to assess their own compe- tencies. So everyone will know where they fit into the jigsaw and what their respon- sibilities are.

Dr Craig says the framework ‘will give people liberal but robust guidance on how to do this safely. They can use it to audit

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what they are doing now and to set up new schemes.’

The paper recommends that ministers set up teams of auditors based at NHS Executive regional offices to ‘sit down with organisers of schemes and use the framework as an audit,’ Dr Craig says. The auditors would look at how information about a patient is transferred between doctors, nurses, physiotherapists and exercise professionals. The system should be self-funding, with audited schemes paying a quality assurance fee.

The framework is not designed to be a didactic document. Instead it will describe best practice, acting as a ‘model’ for exercise referral schemes.

Exercise professionals’ own competencies will be decided on the basis of training. Mr Robin Gargrave, director of Fitness Industry Training at the YMCA is working with SPRITO, the national training organ- isation for sport and recreation occupa- tions, to develop ‘industry standard’ qual- ifications to meet that need.

The basic National Vocational Qualification, at level two, was launched last year. It will allow assistant instruc- tors to work with the ‘apparently healthy’ and screen people for fitness. Level three, for advanced instructors, is due to be pre- sented to the awarding bodies forum next

month and will go live later this year.

The level three qualification will enable exercise professionals to design pro- grammes for patients managed in primary care. Instructors will be expected to liaise with doctors.

Level four is a still a long way off. Mr Gargrave says: ‘My opinion is exercise for the severely ill should remain in hospitals. I would not want to see fitness profes- sionals in white coats.’

He insists that ‘in 99 per cent of cases with low to moderate risk, the benefits of exercise far outweigh the risks.’ ‘It is a matter of confidence building between the exercise professionals and the GPs.’

Dr Andy Brewer, a GP at the Littledown Centre in Bournemouth has been involved in a local referral scheme which has been running successfully for over five years.

He has also developed a training course for fitness instructors which he says ‘allows them to marry up their expertise with some medical knowledge.’

Developed with several university depart- ments of sports science, the course is based on national coaching guidelines and is aiming for NVQ Level Two status. It is backed by the Institute of Leisure Amenities Management.