Updated on21/08/2013
Bath & North East Somerset’s
Exercise Referral Scheme
Passport to Health Service
1 Somerset
Bath & North East
The place to live, work and visit
Contents
Introduction
Overview of the scheme
Referral Guidelines
Operating protocol for Referrers
Operating protocol for Referral Exercise Professionals
Activity Pathways
Help us to help you
3
4
5
6
7
8
9
Appendices
Referral form
Irwin & Morgan Risk Stratification Tool
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11
2
Introduction
This guide has been produced in response to the National Quality Assurance
Framework (NQAF) for Exercise Referral Systems (2001) and Professional
and Operational Standards for Exercise Referral: The Joint Consultative
Forum of Medical Royal Colleges, The Faculties of Health & Sport and
Exercise Medicine, The Chartered Society of Physiotherapy and the Fitness
Sector of the United Kingdom (2011).
The guide aims to provide all professionals involved with the Passport to
Health Scheme a point of reference when referring to the programme,
ensuring a standardised and consistent service is offered equally to all of its
users.
Updates to material included in this guide will be issued by the Project Officer
- Health, who will request that you take responsibility for replacing the out-ofdate information with the new material.
Receiving this guide and adhering to all guidelines, procedures and protocols
provides accreditation to the Passport to Health referral service.
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Overview of the Scheme
The Passport to Health Service has developed and expanded to offer a range
of physical activity interventions based at local leisure facilities and in other
community settings.
In October 2011, the Healthy Lifestyle Referral Hub launched, enabling
anyone wishing to access stop smoking, healthy eating, weight management,
lifestyle advisor and physical activity services to do so via one single referral
form. Consequently, any referrals to the Passport to Health programmes go
directly through the hub and are then processed by the Council’s Project
Officers – Health.
All programmes that form the Passport to Health Service aim to target
sedentary individuals who also present with one or more other health related
risk factor(s). The objective being to assist them in increasing their activity
levels to help reduce their risk of coronary heart disease (CHD), and other
diseases, and help combat the symptoms of mild to moderate depression and
post-natal depression (PND).
Individuals referred to the service are assessed and, where eligible, are
offered a 12 week programme of exercise based on their needs. Costs for
activities are heavily subsidised and all clients will attend pre- and postexercise assessments to establish the impact the service has had on their
activity levels and health risk.
Any healthcare professional with access to an individual’s medical notes, who
is able to complete the referral form in full, is able to make an official exercise
referral. All other professionals are advised to recommend the programme
by completing the top section of the hub referral form. Medical consent will
then be requested by the Project Officers – Health.
All referral consultants responsible for the safe and effective management,
design and delivery of client exercise programmes are qualified in GP
Exercise Referral and registered with the professional body REP (Register of
Exercise Professionals) at Level 3 or 4.
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Referral Guidelines
Referral Criteria
Appropriate Referrals
*Sedentary / Inactive  60 mins moderate
intensity activity per week.
Inappropriate Referrals**
Unstable angina, hypertension, diabetes
Aged from 16 years upwards
Post MI  16 weeks, not attending Phase III
Rehab
All patients must be clinically stable
Unstable or acute heart failure.
Overweight/Obese
Acute Psychosis
Family History of CHD (1st degree relative)
Acute viral illness
Smoker signed up to Support to Stop service
Advanced osteoporosis, osteoarthritis or
severe back pain
Type 2 Diabetes
Uncontrolled tachycardia  100bpm at rest.
BP/Cholesterol Risk
Resting BP >180/100mmHg
Mild to moderate depression
Pregnancy
Post-natal depression
Claudication
Financial barriers
Palliative Care
Social barriers
Physical/mental restrictions
Carer commitments
Please Note: Exercise referral instructors
are not trained to accept the above high risk
conditions as they do not hold additional
qualifications to support these groups.
Clients falling into the above categories
would, therefore, not be appropriate and
must not be referred.
*The GPPAQ may also be used to assess physical activity levels. Those
patients scoring as ‘inactive’ or ‘fairly inactive’ would be appropriate.
** Anyone falling into the high risk category using the Irwin & Morgan Risk
Stratification Tool (see appendix 2) would be inappropriate for referral.
Medico-legal considerations
If referred by a health practitioner:
 Clinical responsibility remains with the referrer.
 Responsibility for safe and effective management, design and delivery
of the exercise programme passes to the exercise professional.
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Operating Protocol for Referrers
1. Referrer identifies clients who are
appropriate for referral
2. Client shows interest in participating and
signs of readiness to change
3. Referrer completes referral form in FULL
4. Referral form is sent by post or fax to:
Healthy Lifestyle Service
The Bungalow
11 Park Road
Keynsham
BS31 1BX
Fax:0117 9872292
5.Hub receive referral and send on to Project
Officer – Health (where Exercise Referral is
ticked) for processing.
5. Project Officer - Health contacts patient to
assess which activity pathway is most suitable
based on their individual needs and arranges
appropriate activity pathway.
6. Referrer receives a feedback letter if client
completes the programme.
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Operating Protocol for Referral Exercise Professionals
1. Project Officer - Health (POH) receives
referral form from hub and contacts client to
assess their needs, assign activity pathway and
advise on next steps.
2. Referral consultant receives paperwork
and a call from the client and books an initial
consultation.
3. Client attends an initial consultation to
discuss health status (using PAR-Q), lifestyle
issues and goals. An activity plan is
established. Baseline measures are recorded
and 6 and 12 week reviews are scheduled.
4. 6 week review is completed in order to
monitor progress and make any necessary
exercise programme/activity pathway
amendments.
Motivational
Lifestyle
Programme
All clients are
invited to attend
a weekly
course aimed
at helping
clients to
establish
healthier habits
related to their
physical and
mental wellbeing.
5. At 12 weeks, clients attend an exit
assessment to discuss a new 12 week action
plan and further goals are set. Baseline
measures are repeated and clients are
signposted to any relevant activity
opportunities.
A 3 month post-programme exit
appointment is scheduled.
6. Client invited to 3 month post-programme
exit appointment. Baseline measures may
be repeated and an evaluation form is
completed to establish activity levels.
(Clients referred with depression have
contact appointments at 14 weeks and 16
weeks before being discharged after 24
weeks)
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Activity Pathways
Once an individual has been referred to the Passport to Health Service and
has been contacted and needs assessed by the POH, one of the following
activity pathways will be offered.
OR
1 x 12 week Programme
Facility-based
programme
 Bath Sports &
Leisure Centre
 Keynsham Leisure
Centre
 South Wansdyke
Sports Centre
 Writhlington Sports
Centre
OR
2 x 6 week Group
Programmes
Group Cycling
Course
Group Aquacise
Course
Group Fitness
Walking Course
Group Circuit
Class Course
Community Activator programme
 1-2-1 exercise programme
delivery for 12 weeks
followed by 1 x 6 week
course or alternative
OR
Give Us A Break Community
Activator programme
 1-2-1 exercise programme
delivery for unpaid Carers
All clients formulate an activity
maintenance plan during their exit
assessment.
Exercise for Depression – clients referred to manage their depression are
prescribed enough exercise to benefit their mental well-being as
recommended by the NICE guidelines. The pathways described above are
offered based on assessment of their needs and preferences.
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Help Us to Help You
This document provides operational details about the Passport to Health
Scheme. It is intended to help anyone involved with referring to the
scheme understand the procedures involved when making a referral and
using the service.
If there is anything which could be made clearer or added to improve you
understanding, please let the Project Officer - Health (POH) know by
contacting:
Project Officer – Health
Sport & Active Lifestyles Team
Bath & North East Somerset Council
Lewis House (1st Floor)
Manvers Street
Bath
BA1 1JG.
Telephone: 01225 396427
Fax: 01225 396459
Email: P2H@bathnes.gov.uk
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Appendices

Irwin & Morgan Risk Stratification Tool
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The Irwin and Morgan Risk Stratification Tool takes the form of a simple traffic
light system, the categories of risk are demonstrated below:
LOW RISK
Overweight
High normal blood
pressure
Deconditioned
Type 2 diabetes
Older people aged >65
Antenatal
Postnatal
Osteoarthritis
Mild bone density
changes
Exercise induced
asthma
Smoker
Stress/mild anxiety
Seropositive HIV
MEDIUM RISK
Hypertension Stage 1
Type 2 diabetes
Type 1 diabetes
Physical disabilities
Moderate OA/RA
Clinical diagnosis Osteoporosis
Surgery – Pre and Post
Intermittent claudication
Stroke/TIA
Asthma
COPD
Neurological Conditions
No complications
(130-139/85-89) not medication controlled
Due to age or inactive lifestyle
Diet controlled
No more than 2 CHD risk factors and not at
risk of
falls
No symptoms of pre-eclampsia / no history of
miscarriage
Provided 6/52 check complete and no
complications
Mild where physical activity will provide
symptomatic relief
BMD >1SD and <2.5 SD below young adult
mean
Without other symptoms
One other CHD risk factor & no known
impairment
or respiratory function
Asymptomatic
(140-159/90-99). Medication controlled
Medication controlled
With adequate instructions regarding
modification of insulin dosage depending
on timing of exercise and warning signs
No other risk factors
With intermittent mobility problems
BMD -2.5 at spine, hip or forearm or _> 4
on Fracture index, with no history of
previous low trauma fracture
General or Orthopaedic. Not Cardiac.
No symptoms of cardiac dysfunction
>1 year ago. Stable CV symptoms. Mobile
no assistance required
Mild (ventilator limitation does not refrain
submaximal exercise)
Without ventilator limitation but would
benefit from optimisation of respiratory
system mechanics and correction of
physical deconditioning E.G YOUNG
ONSET Parkinson’s Disease (stable);
Multiple Sclerosis
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Early symptomatic HIV
Chronic Fatigue Syndrome
Depression
Fibromyalgia
HIGH RISK
Older people >65 years at risk of falls.
Frail older people with osteoporosis
and history of fracture
Unstable and uncontrolled cardiac
disease
Claudication with cardiac dysfunction
Orthostatic hypotension
Stroke/TIA
Severe Osteoarthritis/Rheumatoid
arthritis
Type 1 or Type 2 Diabetes
(Advanced)
Moderate to severe arthritis
COPD/emphysema
AIDS
Psychiatric illness/cognitive
impairment/dementia
Moderately diminished CD4 cells,
intermittent or persistent signs and
symptoms e.g. fatigue, weight loss, fever,
lymphadenopathy
Significantly deconditioned due to
longstanding symptoms
Mild to moderate
Associated impaired functional ability, poor
physical fitness, social isolation,
neuroendocrine and autonomic system
regulation in disorders.
REFER DIRECT TO FALLS
SERVICE
(BMD) >-2.5 at spine, hip or forearm
in the presence of one or more
documented low trauma or fragility
fractures).
REFER DIRECT TO FALLS
SERVICE
Fall SBP -20mg/Hg or DBP -10mg/Hg
within 3 mins of standing
Recent (>3 months ago)
With associated mobility
With associated mobility
With accompanying autonomic
neuropathy, advanced retinopathy
With true ventilatory limitation
With accompanying neuromuscular
complications severe depletion of
CD4 cells, malignancy or
opportunistic infection
AMT score <8
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