Let’s Get Moving – A Physical Activity Care Pathway: Commissioning Guidance

Objectives

Let’s Get Moving (LGM) is an evidence-based physical activity behaviour-change programme and care pathway intended to embed physical activity promotion within routine National Health Service prevention and primary-care services. It aims to identify adults who are insufficiently active, particularly those undertaking less than 30 minutes of activity weekly or not meeting the Chief Medical Officers’ recommendation of at least 150 minutes of moderate-intensity activity per week, and support them to become and remain more active.[1][2][3][4]The programme seeks to improve population health, prevent and help manage inactivity-related chronic disease, reduce premature mortality and health inequalities, improve independence and wellbeing, and reduce pressure on acute, primary-care, social-care and wider public services.[5][6][7][8]

• Promote regular physical activity across sport, recreation, active travel, occupational activity and domestic activity, with gradual progression from inactivity to low or moderate activity as a practical and lower-risk route to health gain.[7][9]
• Support prevention, patient choice and improved standards of care for adults with, or at risk of, long-term conditions, including cardiovascular disease, type 2 diabetes, chronic obstructive pulmonary disease, cancer, obesity, falls risk, depression and other mental-health needs.[1][10][11][12]
• Reduce inequalities in physical inactivity associated with income, sex, age, ethnicity and disability by allowing local commissioning to target particular population groups, neighbourhoods and areas with high health inequalities.[6][9][13][14]
• Integrate physical activity support with related prevention and care pathways, including NHS Health Checks, stop-smoking services, weight-management programmes, falls prevention, cancer survivorship and chronic disease management.[11][13][15][12]
• Contribute to national outcomes ambitions by increasing the proportion of adults achieving at least 150 minutes of moderate-intensity activity weekly and decreasing the proportion classified as inactive.[11]
• Connect patients with accessible, enjoyable and sustainable activity opportunities, including walking, cycling, green exercise, gardening, local groups, leisure activities and condition-specific exercise referral where appropriate.[16][17][18][19]

Implementation

LGM uses a flexible, locally commissioned physical activity care pathway delivered principally through primary care, but adaptable for pharmacies, health trainers, exercise professionals, community providers, leisure services and other health settings.[20][13][21][22]Its five cyclical stages are recruitment, screening, intervention, support for active participation and review, with ongoing encouragement intended to help people sustain behaviour change.[5][11][4]Commissioners are expected to align provision with local needs, Joint Strategic Needs Assessments, inequalities, available activity opportunities and other local public-health initiatives.[23][24][14]

• Identify and recruit inactive adults through new registrations, disease registers, condition-specific clinics, clinical pathways, opportunistic consultations, written or telephone contact, and promotional materials in primary-care premises.[4][25][26]
• Screen activity levels using the validated General Practice Physical Activity Questionnaire, classify patients through its Physical Activity Index, and record relevant activity information in patient records using Read Codes.[4][25][27]
• Provide neutral feedback and offer patients a choice between independent action, an abridged intervention, or a longer discussion with a trained practitioner.[27][28]
• Deliver patient-centred brief interventions using motivational interviewing, exploring readiness, ambivalence, confidence, concerns and options; agree personalised goals, collaborative plans, relapse-prevention strategies and monitoring arrangements.[29][30][28]
• Encourage gradual and safe increases in activity, advise patients to seek advice if new or worsening symptoms arise, and signpost people with specific conditions to appropriately supervised programmes where suitable.[28]
• Provide patient support packs containing practical advice, planning tools and locally tailored activity information, with generic British Heart Foundation material offered to those declining an intervention.[16][23]
• Link patients with local opportunities and establish seamless referral and support arrangements with health trainers, exercise professionals, leisure services, voluntary and community organisations, local authorities, County Sports Partnerships and providers of walking, cycling and green-exercise schemes.[16][31][14][18]
• Follow patients at three, six and 12 months, preferably through the original practitioner, to reassess activity, review goals, address difficulties, reinforce confidence and record follow-up activity or interventions.[1][16][23]
• Train all LGM practitioners in module 1 on physical activity, the pathway, questionnaire use and introductory motivational interviewing; require module 2 or existing motivational-interviewing competence for practitioners delivering the full intervention.[32][33][26]
• Specify objectives, outcomes, target groups, methodology, quality requirements and service levels in commissioning agreements, while ensuring provider capacity, secure information-sharing, consent, confidentiality, clinical governance, risk management and accessible complaints procedures.[31][32][34]
• Monitor service delivery, access, demographic reach, questionnaire scores, brief interventions, follow-up completion, physical activity change, patient outcomes and practitioner and patient experience; use audits, patient feedback and local outcome measures to improve services.[32][14][8]

Monitoring & Evaluation

Monitoring combines population-level surveillance, patient-level assessment and follow-up, service-quality measurement, clinical governance, and local commissioning oversight. The framework relies principally on the General Practice Physical Activity Questionnaire (GPPAQ), Read Codes, follow-up reviews, national surveys and locally agreed service specifications, although a single national evaluation and accountability framework is not specified.[11][32][14][8]

• Measure national progress through Public Health Outcomes Framework indicators 2.13i, the proportion of adults aged 16 and over achieving at least 150 minutes of moderate-intensity activity weekly, and 2.13ii, the proportion undertaking less than 30 minutes weekly and classified as inactive.[11]
• Use the Health Survey for England, Sport England’s Active People Survey and the National Travel Survey to assess activity patterns, sport and recreation participation, and walking and cycling for transport.[2]
• Screen patients using GPPAQ and classify them through its Physical Activity Index as inactive, moderately inactive, moderately active or active; record the category, and where relevant walking activity, in patient records using Read Codes.[4][25]
• Review participants at three, six and 12 months, with further contact where needed, to reassess activity, review progress against baseline, identify barriers, revise goals, reinforce confidence and record follow-up interventions.[16][23]
• Monitor service delivery, equity and experience through the number and demographic profile of people receiving screening and brief interventions, commissioned locations, providers, trained professionals, follow-up completion, activity measures, and patient and practitioner feedback.[32][14][8]
• Include relevant clinical outcomes, where aligned with other National Health Service initiatives, such as blood pressure, body mass index, blood glucose, cardiovascular disease risk score and cholesterol.[32][8]
• Audit providers regularly using GPPAQ data, demographic information, Read Codes and evidence that brief interventions were delivered; use clinical audit, complaints reviews, risk-assessment audits, incident reporting and learning procedures to support quality and safety.[33][34][8]
• Specify objectives, health outcomes, methodology, target groups, quality requirements and service levels in commissioning agreements, supported by local needs assessments, demographic analysis, chronic-disease data, Joint Strategic Needs Assessments and equality considerations.[24][31]
• Use evidence from the feasibility evaluation cautiously: in 14 practices, the pathway was considered feasible and acceptable, but the study was not designed to establish short- or long-term effectiveness.[26][35][36]

Some supplementary interventions have their own evaluation methods. Walking Maps were assessed through telephone interviews and questionnaires, with an interim sample reporting map use and perceived encouragement to walk more.[18][19]The source does not establish a universal reporting timetable, independent evaluation requirement, surveillance threshold or formal accountability mechanism beyond the national indicators, local service specifications, audit and care-pathway processes.[24][8]

Costing & Financing

The economic case presents physical-activity promotion as preventive investment that can reduce demand on health and social care, but funding decisions, service models and set-up costs are predominantly local. No dedicated national Let’s Get Moving budget, allocation, financing source, quantified funding gap or resource-mobilisation plan is specified.[23][13][15]

• Recognise physical inactivity as a substantial financial burden, estimated at £1.06 billion annually in direct National Health Service costs for five conditions and up to £8.3 billion annually when wider costs such as sickness absence and premature mortality are included.[6][3]
• Use National Institute for Health and Care Excellence modelling which includes consultation time, printed materials, intervention reach, effectiveness and health outcomes when assessing the cost-effectiveness of brief physical-activity interventions.[30]
• Assess brief interventions as costing £20 to £440 per additional quality-adjusted life year, below the £30,000 National Health Service cost-effectiveness threshold, with estimated net savings of £750 to £3,150 per quality-adjusted life year gained compared with no intervention.[30][10]
• Consider avoidable service use, as inactive people are reported to spend more days in hospital and make more primary-care, specialist and nurse visits than active people; fractured hips alone are estimated to cost the National Health Service and social services £1.8 billion annually in England.[7]
• Consider local financial incentives, including basic funding for minimum service requirements and outcome-linked payments, while recognising that local delivery method, commissioning arrangements and set-up factors determine actual service costs.[15]
• Use Department of Health economic analysis and supporting costing information to estimate costs of the selected local model and compare value for money with other public-health interventions.[24][31]
• Consider potential savings associated with wider active-travel measures: a 20% increase in cycling by 2015 was estimated to save £107 million through fewer premature deaths, £52 million in National Health Service costs and £87 million through fewer work absences.[3]

Commissioners are encouraged to seek budget approval through established local systems, support financial balance and consider efficient primary-care services that may reduce acute-care demand.[20][23][13]The available material does not quantify training, patient-pack, referral, provider-capacity, implementation or maintenance costs, and it does not identify a funding shortfall.[33][8][26]