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Incentivising health
Has GP referral failed? Given how long it’s been around, its impact has certainly been limited. The finger is often pointed at the referral schemes themselves – a lack of sustainable pathways, for example, and lack of joined-up thinking across the UK. However, there’s also a significant issue among GPs, who often see lifestyle disease as more a social than a medical problem, have little understanding of the benefits of exercise, and have no financial motivation to refer. This represents a serious conflict of interests, and it’s preventing us from making real inroads. The responsibility lies in large part with government, which has yet to fully align its policies with its stated
intent of addressing the problem of lifestyle disease. It has so far focused on ‘nudging’ consumers towards better health habits, leaving the obvious gap of GP incentives unplugged: the Quality and Outcomes Framework incentivises UK GPs to refer patients into smoking cessation schemes, for example, but not to refer people into exercise – this in spite of a report, published last month in The Lancet, which suggests inactivity is killing as many people across the globe as smoking (see p11). This has been recognised by the Royal College
Imagine a future where GPs see the value in exercise and are incentivised to refer. We can help bring this about, but we must be truly cognisant of the challenges we face
of Physicians in its new Exercise for Life report, which cites the lack of financial or quality incentive as a key challenge to exercise referral. And it’s not just a UK problem. On his
website
www.takebackourhealth.org, US-based expert Dr Mark Hyman (see p32) draws attention to the “perverse financial incentives” which exist in the US healthcare system. He explains how a successful diabetes prevention
and treatment programme in New York City was cancelled by the hospital when its revenue dropped. “Cutting off a diabetic toe and receiving US$6,000 from Medicare is better than being reimbursed US$100 for a nutrition consultation,” he observes. “The system profits from having more sick and fat patients.” Nevertheless, progress is being made with the medical sector: Exercise for Life names the FIA as “a
key collaborator for the medical profession” and outlines recommendations to ensure that exercise becomes a routine part of the prevention and management of chronic conditions (see p10). However, until government acts decisively, ensuring referral is in GPs’ financial interests, progress will be slow. So what can we do in the meantime? At present, GP training does not cover exercise science; most GPs are
not even aware of the latest physical activity guidelines, according to last month’s House of Lords Science and Technology Committee report (see p12). We can help plug this knowledge gap by providing scientific evidence of the benefits of exercise, encouraging GPs to see lifestyle disease, and its solutions, as a medical concern. GPs must also experience the benefits for themselves. A study published in Obesity in January found that
physicians with an elevated BMI were far less likely to diagnose obesity, or bring up weight loss with obese patients, unless they felt patients’ bodyweights matched or exceeded their own. We need to win GPs over one by one, bringing them into our gyms and turning them into advocates based on personal experience. And all the while, we need to lobby government and the NHS to incentivise exercise referral. Imagine a future where GPs see the value in exercise and are incentivised to refer. We can help bring this about, but we must be strategic and unified in our efforts, and truly cognisant of the challenges we face.
Kate Cracknell, editor –
katecracknell@leisuremedia.com / twitter: @HealthClubKate To share your thoughts on this topic, visit
www.healthclubmanagement.co.uk/blog
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