Application for the Shropshire Council Public Health

Exercise on Referral Register

Introduction

Physical inactivity is a serious and ever increasing Public Health concern and being inactive is recognised as a modifiable risk factor for many health conditions. Being active can help to lower the risk of developing as many as twenty diseases or disorders including coronary heart disease, stroke, type 2 diabetes and certain types of cancer, whilst also aiding the management of many health conditions. National surveys suggest that as many as two thirds of the population are not active enough to benefit their health. Shropshire Council Public Health (SCPH) aims to influence this by supporting people to adopt healthier lifestyles through the development in access to healthy living opportunities and increasing

What is Active4health?

Many of us understand that increasing physical activity levels isn’t always easy. There are many factors that can hinder changing any current behaviour, these include:

  • the pressures of everyday life
  • the lack of knowledge about exercise
  • the inability to find out what is suitable and available locally

These three factors, amongst others, make changing physical activity habits a difficult task for most. The aim of Active4Health is to assist all sedentary individuals in accessing suitable exercise opportunities, achieved by creating a system where local provision, tailored to the needs of sedentary individuals, can be easily found and accessed; Active4health takes the form of a webpage based within the SCPH website. All exercise providers will have class details published on the webpage and made freely available to the public. The webpage also offers the chance to provide up to a hundred words of text to best describe the class/activity being registered, include what’s involved and what prospective clients/patients are likely to experience.

Exercise on Referral is also promoted as part of the ‘Lets Get Moving Physical Activity Care Pathway’, locally delivered through a weight management service, encouraging exercise and referrals where appropriate. For more information on ‘Let’s Get Moving Physical Activity Care Pathway’ visit:

Entering the Active4Health Exercise on Referral Register

Prospective Exercise on Referral providers must complete and submit both the application and declaration forms in full, supplying additional information as required. Entering the register does not replace any current national quality assurance mechanism which all providers are duty bound to work to, the register is intended to unify adherence to good practice in Shropshire and support appropriate patient referral into Exercise on Referral programmes. Registration is based on both the National Quality Assurance Framework (NQAF) and British Heart Foundation Exercise on Referral guidance.


REGISTRATION DETAILS

Date // Centre Name

Address

Post Code:

Phone No: Fax No:

E-mail

In order for this Exercise on Referral provision to be placed upon the Active4Health register held by SCPH, you are required to confirm that this provision conforms to the National Quality Assurance Framework guidelines for Exercise on Referrals. Please indicate below whether or not your provision has the following:

YES

L3 Exercise on Referral REPS recognised qualified staff

L4 Qualified staff

Otago Qualified staff

Professional indemnity, public liability & premises insurance cover

A secure records holding and management system

Private consultation area

Facilities including equipment (brief description)

Pricing structure/charge for Exercise on Referral patients

Planned method of assessment/monitoring and proposed frequency of liaison with GP

Please provide in no more than 100 words, using clear, simple and friendly descriptions your Exercise on Referral provision. This information will be included in the Active4Healthwebpage

If necessary please attach additional pages to this application

Declaration Form
By signing this declaration form you are verifying a commitment to work to best practice guidance set at a national level through the NQAF, and locally throughActive4Health.
I/We of: (state name of organisation) _ _ _
1)Certify that all information submitted to Active4Health is correct and that the aforementioned organisation has suitable insurance arrangements.
2)Certify that the premises and equipment of the aforementioned organisation comply with the Health and Safety Executive Regulations.
3)Agree to work to the guidelines set by the National Quality Assurance Framework for Exercise Referrals and adhere to the Active4Health Exercise on Referral Framework.
4)Agree to update SCPH on pricing, personnel amendments and changes in provision.
5)Agree to facilitate any inspection of premises and equipment by SCPH at mutually convenient times.
6)Agree to respect patient confidentiality at all times.
7)Agree to only assess and monitor those patients/clients who fall within categories covered by staff trained to the minimum standard unless accredited additional training has been given to instructors.
8)Reserve the right to refuse or terminate Exercise on Referral sessions for an individual client.
Signed (Manager/Proprietor) _ _ _
Dated //
Office use only
Date received // Date approved //

Please return completed Registration forms to:

Hannah Thomas

Project Manager

Help2Change

Longbow House

Longbow Close

Shrewsbury, SY1 3GZ

Tel: (01743) 454910

Email:

  • Both the instructor and details of the class, once registered, will be entered onto the webpage
  • Shropshire Public Health maintains all editorial rights to all information being uploaded onto its website