Green Prescription expands into Bay of Plenty communities

Despite a 22 per cent increase in referrals to the Green Prescription programme since 2021, a focus on adapting the service to individual client needs is reducing waitlists and enabling greater engagement with clients in community settings.

Funded by Te Whatu Ora Health NZ and primary health organisations, Green Prescription is a six-month healthy lifestyle programme for adults delivered by Sport Bay of Plenty in the Eastern, Western and Central Bay of Plenty districts. The nationwide initiative, which began in 1998 and is mainly administered by regional sports trusts throughout the country, supports clients to establish sustainable physical activity and nutrition habits, and has proven to be a highly cost-effective primary care intervention.

Sport Bay of Plenty’s General Manager Strategic Partnerships, Larissa Cuff, explains traditional Green Prescription service delivery involves a referral from a GP, a face-to-face meeting in an office plus phone call follow-ups, and support to access community activities such as aqua classes, walking groups or gyms.

“Although effective, this delivery model has its limitations given it is a ‘one-size-fits-all’ approach. As such clients with more complex needs – such as those supporting multiple family members, or people who live in more isolated areas who can’t afford to travel – face several barriers and challenges when attempting to engage with the service.”

In essence, explains Larissa, although Green Prescription has been highly successful, it has struggled to attend to clients whose needs don’t match a structured and traditional way of service delivery. This includes clients who don’t have the means to travel for appointments, younger clients in the whānau programme, or Māori and Pasifika clients who take a more holistic view to health that encompasses family, social, spiritual and emotional wellbeing, rather than strictly individual physical wellbeing.

Larissa also notes the ongoing impacts of the pandemic, and the success and popularity of the programme, have contributed to a dramatic increase in referrals since 2021.

“In the 2023-’24 financial year referral numbers were 22 per cent higher than they were in 2021-22. In fact, back in 2022 there were indications of a rapid growth in demand and need for the Green Prescription service when our waitlist grew by a dramatic 91 per cent compared to the previous year.”

All this highlighted a need to enhance the service to ensure waitlists were managed or ideally reduced, the standard of care and engagement was maintained or enhanced, and harder to reach clients had equitable access to the programme.

The answer to meeting growing demand while maintaining quality and increasing equity was found via implementing a tiered service approach. This evolved service model has effectively reduced client waitlists and wait times while also maintaining or increasing client engagement and looking after those with the greatest need.

Clients on Green Prescription now undergo an initial assessment to determine their unique needs. They are then classified into one of three tiers based on the acuity of care that will best support them to make sustainable healthy lifestyle changes.

Lower acuity clients are supported with phone consultations and information regarding physical activity options such as gym memberships or community exercise classes.

“These clients have typically requested a Green Prescription referral themselves from their GP and are therefore just looking for suitable physical activity options and a little bit of support to get active,” explains Larissa.

By offering this streamlined service to clients with lower support needs, Green Prescription advisors now have more time to adapt and provide greater support to ‘tier three’ clients who are harder to reach under a traditional service structure, or who have more complex needs.

These tier three clients are now supported with a mix of increased in-person and phone consultations, encouraged to engage whānau as a support network, provided with nutritional advice, supported to engage with Green Prescription led groups, and connected with appropriate physical activities in their community.

“The tiered service approach has meant we have more time and resource to develop a community Green Prescription programme that understands and minimises barriers for certain populations such as Māori, Pasifika and whānau.

“As a result, our Green Prescription programme is more responsive to these clients by meeting with clients in their own communities and embracing local opportunities that connect to Te Whare Tapa Whā health model.

“We also have more time and resource to work more collaboratively with the community, including Māori health and community organisations, and to offer a service in isolated communities. This is enabling us to better tailor the programme to be more equitable for those clients unlikely or unable to engage with the traditional Green Prescription model.”

Larissa and the team see this as a breakthrough in the service that will pay dividends in the long run.

“Thanks to this evolved approach that identifies individual needs at a triage point, a highly successful national initiative is now embracing the opportunity to be more locally-led and accessible for all New Zealanders.”