Table 4 Reinforcements for awareness of the scheme – sub-themes (Theme 3)

Instructor efforts

We do go out now and again to GP’s. Try and target GP’s who are not referring or maybe we’re getting inconsistent referrals from them. Uncompleted forms, that kind of thing. So it tends to be more of a fine tuning exercise now rather than actively recruiting. We’ve already done that. (12)

It’s been continuous having to knock on doors of medical professionals, keep it in the forefront of their minds and try and keep them referring. So we’ve done that by quality of service but what we really need is help from the top coming down. (20)

Well, the fact that they are very good at what they do (3)

Self-referral

So I know there is a large number of our referrals actually make a point of going to their GP or Practice Nurse and requesting that they’re referred. (18)

The other element of it is that as it’s more well-known, and people know that it is a cost effective way of exercising, so it’s cheaper than your traditional gym membership, I think that has a big impact on how many people want to be referred as well. (7)

I think I asked the nurse because I saw a sign on the wall outside the surgery that there was some kind of, exercise referral group. And by then I was willing to try anything to try and help resolve my problems. (19)

…certainly, from the managing your own conditions there is a bit of a scheme in the borough for managing long term health conditions and people used to be able to self-refer to but I think it’s a consultant referral now. (2)

So I would refer anybody who asked for it. I don’t think I would ever refuse someone who has requested it… think you can almost always find a reason to … you know if someone asks for it, it’s very difficult not to find something to send them in for so … I mean if they were 30, completely fit and well, no anxiety and depression and just wanted to go to the gym for free, perhaps I would suggest there might be other routes to go down but I haven’t had that scenario. (1)

I don’t know whether patients can self-refer. I don’t think that they can but I think if they could self-refer that would be more beneficial for them, so that they didn’t have to come see us and, and to get a referral from, from primary care. (4)

I probably don’t push it enough even though I think it’s a really good idea. Definitely I think exercise is the answer to most of the problems we see, a lot of them anyway. I probably don’t push it enough. I probably wait for people to ask for it. … … it’s rare that I look back in notes and that I see doctors have, say, encouraged to go on exercise program scheme. It’s usually a patient wants to go on, so I’ll refer. (2)

Primary care feeder

I think it’s just because it’s a natural progression from people who have gone to see the physio for exercise, and it’s a natural progression, a natural exit route for them to do really, so I think it makes sense, whether they’re the right people to be referred or not, I don’t know? But we do have a high percentage of them coming through. (22)

I think there’s definitely a case sometimes of let’s pass that on to somebody else. I think physiotherapy departments are under massive pressure. I get a feeling physiotherapy in (area) wouldn’t even be able to cope without us. (12)