What is a NHS GP Exercise Referral Scheme?

The NHS GP Exercise Referral Scheme is a leading initiative that uses the power of physical activity to improve the health and well-being of individuals who need the support. 

As the Chief Medical Officer said in 2019, “If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.” 

This statement underpins the incredible potential of exercise referral programmes in supporting recovery and maintenance for those managing health issues and chronic conditions.

Exercise referral schemes were first introduced into NHS primary care in the 1990s. But they’ve gained popularity in recent years, as more people become aware of its benefits for a wide range of conditions, including high blood pressure, diabetes, obesity and depression. By providing a structured and supportive pathway to increased physical activity, the NHS GP Exercise Referral Scheme aims to transform lives, whilst empowering individuals to make long-term, sustainable changes for the good of their health.

This article will talk you through all you need to know about the NHS exercise referral scheme, how it works, who’s eligible and how to get involved as an exercise specialist.  

What is an NHS Exercise Referral Scheme?

The NHS GP Exercise Referral Scheme is a funded health initiative in the UK. Its aims are simple: to increase physical activity levels among individuals who are sedentary, inactive or living with common medical conditions. 

The exercise referral scheme takes a structured approach to improving public health through physical activity. First of all, this involves a general practitioner (GP) who assesses a patient to determine whether they are right for the scheme. If so, the patient will be referred to become a participant where they receive a tailored exercise programme via a gym that is signed up to the scheme. 

The NHS GP exercise referral scheme is specifically designed for patients who have existing health conditions or are at risk of developing them. This collaborative effort between healthcare providers, fitness professionals and participants usually takes place over an initial 12 week period. In Wales, this may be over a 16 week period. 

nhs gp exercise referral scheme bad back


By participating in safe and supportive structured exercise programmes that are customised to their health needs and abilities, the aim is to increase confidence of participants, promote long-term behaviour change and enhance overall health and well-being.

Exercise referral schemes play a crucial role in the UK’s efforts to combat chronic illnesses associated with inactivity, such as heart disease and diabetes. By offering an accessible pathway for patients to incorporate exercise into their daily lives, the NHS GP exercise referral scheme helps to create healthier communities, whilst reducing the burden on the healthcare system. The hope is that these schemes can serve as an alternative or complement to prescription drugs for certain conditions, potentially reducing the number of patient visits to the doctor.

Goals of the NHS GP Exercise Referral Scheme

There are a number of primary goals to the NHS exercise referral scheme:

  • Reduce the risk of chronic diseases such as heart disease and diabetes
  • Prevent the likelihood of developing common health conditions, such as obesity, high blood pressure and asthma  
  • Improve physical fitness and mental well-being
  • Encourage long-term lifestyle changes towards increased physical activity

Benefits of Physical Activity

The National Institute for Health Care and Excellence estimate that low levels of physical activity could lead to as many as 36,815 premature deaths in England each year. This statistic tells us the crucial role that regular exercise plays in maintaining and improving both physical and mental health. 

The NHS recommends that adults should be active daily, accumulating at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity across the week. They also recommend not to be sedentary for long periods of time. According to the recent Health Survey for England, only 70% of men and 59% of women over 16 meet these guidelines.

Alongside being generally active, the NHS says that adults should take part in two strength training sessions a week to work the major muscle groups. Did you know that muscle mass in older adults is a better predictor for living longer than BMI?

Engaging in physical activity consistently can bring substantial health benefits, including reduced risk of chronic diseases, improved psychological well-being, better weight management, enhanced muscle and joint function, plus improved heart health and circulation. What’s more, regular exercise not only helps manage and control existing conditions but also serves as a preventive measure against the development of additional health complications. 

nhs gp exercise referral scheme instructor female

Less well-known is the benefits that physical activity brings for mental health. It’s likely you’ve heard of the ‘feel good’ hormone endorphins. There’s indirect evidence to show that exercise triggers the release of endorphins but more importantly, physical activity does stimulate the release of various other beneficial chemicals in the body and brain that contribute to positive mental feelings. These include:

  • Dopamine
  • Serotonin
  • Acetylcholine
  • Noradrenaline (the brain version of adrenaline)
  • Cortisol

Looking more closely at the science, recent research has shown that resistance exercise can stimulate parts of the brain that are typically unresponsive during depressive episodes, leading to enhanced feelings of well-being. It’s been shown that strength and resistance training can improve mood, reduce negative emotions and alleviate depressive symptoms. 

By incorporating regular physical activity into daily life, individuals can experience a wide range of physical and mental health benefits, ultimately contributing to a longer, healthier, and more fulfilling life.

Who is eligible for the NHS Exercise Referral Scheme?

The NHS GP Exercise Referral Scheme is designed for patients who are sedentary or have health conditions that could be improved through physical activity. 

To access this service, patients must meet specific criteria as determined by the GP before they can go through the structured referral process. So, the first port of call to get an exercise referral is to get an appointment at your GP practice and enquire about the referral process.

Your GP should be aware of the local referral programme and will be able to evaluate the benefits before deciding on a GP referral to a gym. GPs and health professionals identify patients who would benefit most from an increase in physical activity, especially those who are sedentary or inactive but generally healthy. In the next section we’ll talk about the specific criteria that patients will be assessed on. 


Access criteria to the Exercise Referral Scheme

To be eligible for the NHS GP Exercise Referral Scheme, patients must meet certain criteria. These criteria typically relate to the presence of a health condition that could be managed or improved through exercise.The patient’s current level of physical activity is also considered, with a focus on those who are not meeting the recommended physical activity guidelines.

The scheme is aimed at inactive adults, 16 years and over. Eligible individuals will be doing less than 30 minutes of physical activity per week and have a moderate risk of developing a long-term health condition. If patients are already exercising twice a week and have been regularly active for a few months, it’s unlikely that they’ll be accepted onto the scheme.

Here’s a run down of some of the criteria and common health problems that are recommended for referral onto the scheme:

  • Adults over 16 years old
  • Doing less than 30 minutes of exercise per week
  • Overweight or obese 
  • BMI over 30
  • Type I and II diabetes
  • Asthma
  • High blood pressure
  • Mild to moderate mental health problems, such as depression or anxiety
  • Arthritis
  • Osteoporosis
  • Post physiotherapy joint conditions, for example affecting knees, hips and shoulders
  • Cardiovascular disease including a family history of heart disease

nhs gp exercise referral scheme health condition

It’s important to note that this scheme is not appropriate for high-risk individuals. The doctor will be able to determine this, but individuals with the following conditions won’t be suitable for exercise referral:

  • Unstable hypertension
  • Unstable angina
  • Unstable diabetes
  • Severe coronary heart disease
  • Unstable and/or severe mental health problems
  • Pregnancy (if previously sedentary)

How do I get referred to the Exercise Scheme?

The process for the NHS GP Exercise Referral Scheme starts with an assessment by a GP or registered health professional, such as a nurse, physiotherapist or healthcare assistant.

Once you’ve had a chat and an assessment based on the above criteria eligibility, they will complete a referral form and provide the patient with an information leaflet about the scheme. 

In most cases, the referral form is then sent to a participating exercise facility or gym. It’s important to note that GPs can only send patients to facilities that have a NHS GP referral contract for their local area and not any old personal trainer. More often than not, these facilities are generally council-run leisure centres in the local vicinity. 

What happens after a GP Referral?

Ok, so the patient has been referred. What happens next?

Once referred to a suitable gym or facility, qualified staff from the gym will get in touch and arrange a time for the patient to come down. 

Alongside the GPs notes, the qualified exercise referral instructor at the gym will conduct their own screening and have a chat with the patient. There will then be some form of assessment by the exercise referral instructor, during which goals and an action plan will be set. 

The specialist instructor will then design an appropriate exercise programme that’s tailored to their needs and enjoyment. Motivation and adherence are both key here for long-term change. The exercise referral programme can be made up from a variety of activities, such as gym sessions, exercise classes and swimming. 

nhs gp exercise referral scheme instructor and participant

The exercise programme is usually tailored over a 12 week period. At the six week mark, an assessment will take place to evaluate progress towards the goals. There will be a final assessment at week 12.

For fitness professionals interested in supporting patients through the NHS GP Exercise Referral Scheme, you’ll have to have a Level 3 Exercise Referral qualification. To gain this qualification, you’ll need to be a qualified Level 2 Fitness Instructor as a minimum. 

The Fitness Group’s comprehensive Level 3 GP Exercise Referral course equips individuals with the knowledge and skills necessary to design and deliver safe, effective exercise programmes for patients with various health conditions to improve overall health and well-being. The nationally accredited Diploma qualification which is awarded by Active IQ and recognised by Ofqual.

Do participants have to pay for the NHS exercise referral scheme?

The NHS GP exercise referral scheme is a part-funded scheme. This means that funding is available to subsidise a gym membership in a partner facility. It doesn’t mean that participants get a fully funded, free gym membership. 

In most cases, a GP referral means the patient will get a partly discounted membership for an initial period of time. When the referral programme has ended, the patient will have to pay for any on-going services and memberships, although these may be available at concessionary rates. The specific financial arrangements may vary depending on the local authority and the participating gym.

How long does a GP exercise referral go on for?

A NHS GP exercise referral scheme usually takes place over 12 weeks. The Wales National Exercise Referral Scheme provides a 16 week programme of physical activity. 

During this period, participants are encouraged to attend at least two sessions per week to maximise the benefits of the programme. At the six week stage, there will be a progress review. This halfway review will go over the goals set, discuss how the programme is going for the participant and make sure they’re generally happy and motivated to continue for the second half. 

At the end of the 12 week programme, there will be a final evaluation to assess the patient’s progress, determine the overall outcome and potentially address any next steps. If the patient has adhered to the exercise plan consistently, positive results are expected.

In cases where the programme has been a success, both the GP and partner fitness facility strongly recommend that the patient continues their fitness journey by purchasing a membership. The lines up with the ultimate goal of promoting lasting behaviour change, encouraging long-term commitment to regular exercise and reducing GP appointments.

Becoming an Exercise Referral Instructor

nhs gp exercise referral scheme instructor

An exercise referral instructor is a specialised fitness professional who is certified to support individuals with various medical conditions. They work specifically with individuals referred by a doctor or healthcare practitioner under the NHS GP exercise referral scheme with the aim of increasing health, fitness and well-being over a certain amount of time. The longer term goal is that an exercise referral instructor can equip participants with knowledge and confidence to take more self-control over their health. 

As part of their role, a specialist exercise referral instructor possesses the skills to conduct assessments, adapt programming, monitor progress and tailor exercise programmes specifically for referred clients based on their needs and condition. 

To become an exercise referral instructor, you must complete a Level 3 GP Exercise Referral Course, such as the one offered by The Fitness Group. With a Level 3 GP Exercise Referral qualification, you can effectively assist these referrals and make a positive impact on their physical and mental health. The only pre-requisite you need to have to enrol on the GP exercise referral course is to be a qualified Level 2 Gym Instructor

Becoming a specialist Level 3 Exercise Referral instructor helps to expand your potential client base. If you are already working in a gym setting, you may find that some existing members have been referred and can benefit from your specialised support. 

Even more, gaining this qualification will open up additional career progression paths. You can continue your professional development by studying the Level 4 Low Back Pain or the Level 4 Obesity and Diabetes management course. Both are popular Level 4 qualifications offered by The Fitness Group.

Overall, the Level 3 GP exercise referral course is a great qualification to have if you’re looking to increase your personal trainer salary and develop a self employed business

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