Active practice project – students learning through evaluation

Problem

A London CCG and the Local Public Health team developed a pilot “Active Practice Project” (APP). Primary care medical undergraduate core curriculum currently includes evidence-based approaches to behaviour change and social and exercise prescribing, with a “Script” for guidance regarding exercise prescribing. Students, however, were not seeing this translate into their clinical placement experiences. We enabled our “Script” to be modified to be used with the APP, linking exercise prescribing to the local referral options and an innovative mobile phone App. The GP record system, SystmOne, used by local CCG practices, was used to record related clinical activity. Four 3rd year medical students at King’s College London (KCL), doing an optional Health Promotion module, were invited to engage with the early implementation evaluation of this pilot.

Approach

The students evaluated specific aspects of the pilot, exploring the experiences of the participating GPs and their practices in prescribing and promoting physical activity. They familiarised themselves with the pilot, designed a topic guide for GP and practice manager interviews and arranged interviews. The digital data were sent to the KCL module supervisor who arranged for secure storage and transcribing. Content analysis of the data and other available information was examined to provide an interim report of the work in progress and recommendations.

Findings

Eight practices initially agreed to participate, with a July 2017 launch, although by Autumn 2017 only four practices were participating. The students had limited availability and found it difficult to book interviews as there was some perceived resistance. Two participating practices agreed to be interviewed, the lead GP at one practice and the practice manager at another. Both interviewees agreed that it was the role of primary care to be promoting physical activity and be locally contextually relevant. However, they differed in how they valued prescribing physical activity. The GP felt this was imperative when a local infrastructure was available to support the “script”, although the time needed was a potential obstacle. The practice manager expressed concern that it was time consuming, with potential deleterious resource issues, and it was not appropriate for doctors to do this. They felt provision of local information and disseminating details about activities was appropriate and sufficient.

Consequences

Considerable work is still needed to “normalise” these interventions regarding physical activity. Protected clinical time, ongoing support, and process evaluation will be needed to increase and normalise physical activity prescribing to inform Active Practices. The data was limited yet it is important to acknowledge that where there is enthusiasm and commitment, promoting Active Practices has potential. Students experienced the challenges of implementing and evaluating Health Promotion interventions, with the importance of ongoing well-planned interventions being resourced and evaluated to gather evidence to inform further developments.