What is NERS & How Do I Refer To NERS Jeannie Wyatt-Williams National Exercise Referral Coordinator for Wales May 24th 2016

NERS Introduction The NERS programme has been in development since 2007, and was subject to a RCT evaluation. http://wales.gov.uk/about/aboutresearch/social/latestresearch/?lang=en National Coordinator appointed by Welsh Local Government Association in August 2008 to develop the chronic conditioned pathways This led to development of two distinct but interrelated elements of the NERS programme; Level 3 pathway for patients at risk of or with a mild /moderate medical condition Level 4 pathway for clients with a chronic condition. .   To establish the NERS & Health pathway as an effective bridge from health into leisure by supporting patients in supervised activity, building their confidence enabling them to go forward and undertake mainstream activities to maintain and continue to improve their health and wellbeing the priorities were: Training, development and implementation of standard protocols, partnership development with health professionals, third sector, partner projects and leisure mangers to ensure development of appropriate exit routes.

Patient Centred Pathway Health Interface Primary Care Rehabilitation Programmes   . Primary Care Brief Intervention Lifestyle Advocates Jeannie Wyatt-Williams NERS National Coordinator for Wales 2015 Health Education Programmes Secondary Care Mainstream Leisure Personal Trainers Community Classes Active Daily Living/Home Based Exercises Exercise Conservation Walking and Cycling Groups Golf Dance Adapted Sports/Walking Football NERS Level 3 Generic Exercise Referral Swimming INTERGRATION OF HEALTH AND THE NATIONAL EXERCISE REFERRAL SCHEME IN THE PREVENTION, TREATEMENT AND MANGEMENT OF CHRONIC CONDITIONS Health Interface LHB health promotion initiatives Foodwise4Life Nutritional Education Programme NERS Programmes NERS Level 4 Condition Specific Rehab Pathways Independent Activity

Qualification & Evidence . Qualification EP’s Qualified Number of weeks Research Evidence for Delivery and best practice Generic L3 174 16 NERS interventions & ACSM Condition specific guidelines. BACPR 139 8-32 BACPR Guidelines L4 Respiratory 85 4-32 Loughborough College/Leicestershire Hospital and ACSM Condition specific guidelines PSI L4 80 48 FaME & OTAGO EfS L4 37 16-32 Starter L4 Back Care 41 ACSM Condition specific guidelines L4 Mental Health 46 16- 32 L4 Obesity 53 L4 Cancer 43 Macmillan Concise evidence review & ACSM Condition specific guidelines Parkinson’s Pilot 42 LLT tutor current practice and FaME NERS delivery approved by CSP Neurological Physiotherapist & Parkinson’s nurse .

NERS Generic Process Chart Exit to suitable activities Exercise sessions led by NERS Level 3 qualified instructors x 16 weeks 16 week re-assessment of all previous tools, review goals No Depending on assessment outcomes co morbidities /readiness to change Exit to suitable activities 4 week review goals & signpost to exit routes as appropriate remembering to complete 16 week re- assessments 52 weeks review of all previous tools, review goals GP/AHP to determine if client meets criteria Yes GP/AHP Provides information about the scheme Patient wants scheme GP/AHP completes referral form and informs patient they will be contacted within 4 weeks. Patient does no want scheme GP sends referral form to local coordinator Coordinator/EP sends referral update letter to GP at 16 week stage No further action NERS referral form received and checked by Coordinator; a suitable Exercise Professional is identified and a letter sent inviting them to 1:1 consultation or open sessions as appropriate Exit to suitable activities NERS EP completes 1:1 consultation to include: Informed consent Health questionnaire Goal Setting SPAQ WEMWBS Height/Weight/BMI 6 Minute Walk etc. EQ-5D

How do I Refer www.nersdb.info The link will take you to the site which you can enter with a password you can access site in English or Welsh. Once on site you choose your local authority area This opens up a menu of chronic conditions that area can deliver evidenced based physical activities to. You can check exclusion criteria and open up referral form which can be either completed on line and saved or printed for completion. This on-line referral dispensing system has been developed with no additional funding to give better access to information and hopefully make it easier to refer to the correct programme. It has been piloted in a few surgeries in Powys and has now been shared locally It is hoped to eventually develop a fully electronic referral system the stumbling block has been Health Intelligence are concerned about transferring patient data to a non NHS email account; I will continue to strive towards the goal but feedback has been this is an improvement on the referral form offering GP’s more information about what is available in your area

To use the system Point your web browser at www.nersdb.info and then: 1) Select your county 2) Type in the password which you can get from your local coordinator http://www.wlga.gov.uk/co-ordinator-contact-details/ 3) Click next which will take you to the dispensing page. This on-line referral dispensing system has been developed with no additional funding to give better access to information and hopefully make it easier to refer to the correct programme. It has been piloted in a few surgeries in Powys and has now been shared locally If you click onto the HERE it will take you to two documents the NERS health professional leaflet and the M2M flyer

Dispensing Page Please ensure you make a note of the local coordinators postal address where you will need to post referral form to once completed before selecting the appropriate referral form The Referral form can be downloaded and saved on desktop for completion or printed out and completed by hand There are VISION compatible versions of these referral forms available from your local coordinator http://www.wlga.gov.uk/co-ordinator-contact-details/

Thank you / Diolch Jeannie Wyatt-Williams National Exercise Referral Coordinator Website www.wlga.gov.uk/ners E: jeannie.wyatt-williams@wlga.gov.uk T: 029 2046 8516 M: 07500 556045 Thank you for your attention here is the link to the NERS website and my contact details.