Healthy Lifestyles Gloucestershire

Healthy Lifestyles Gloucestershire is an integrated service which provides people with lifestyle support through one single point of access for:

  • Smoking cessation
  • Weight management
  • Alcohol reduction
  • Physical activity support
  • Information and links to more general aspects of healthy lifestyle (including gambling)

Healthy Lifestyles Gloucestershire can also provide support on multiple pathways at the same time, for example, smoking cessation and weight management.

More information is available from the Healthy Lifestyles Service website.

How to make a referral

Referral into the Healthy Lifestyles Service can be made electronically or via telephone on the contact details below. 

Please note: Healthy Lifestyles Gloucestershire Service will attempt to contact a patient within two working days of receiving the referral.

NHS Diabetes Prevention Programme (NDPP)

The NHS Diabetes Prevention Programme (NDPP) is a joint initiative between NHS England, Public Health England and Diabetes UK aiming to deliver services at a large scale, which identify those with non-diabetic hyperglycaemia (those at high risk of developing type 2 diabetes) and offer them a free lifestyle intervention encompassing group educational sessions subject to an evidence-based specification, in order to reduce their weight and increase physical activity, thus reducing their risk of developing the condition.

Local diabetes audits have shown that there are approximately 20665 patients identified in Gloucestershire as having non-diabetic hyperglycaemia (NDH), which equates to 3.2% prevalence.

Please note that as part of Gloucestershire’s Primary Care Offer practices are required to code patients with NDH once identified. Please see below the required Read codes:

  • Read code V2 (Emis Web, Vision & Microtest) – C317
  • Read code V3 (SystmOne) - Xaaep

In line with NHS Long Term plan, it was announced in 2018 that the NDPP will be funded to the end of 2022 and from August 2019 Gloucestershire’s NDPP service will be delivered by ICS Health & Wellbeing.

Please see the Referrer Information sheet for further information.

Patients that have already been referred to Gloucestershire’s previous NDPP provider Living Well Taking Control (LWTC) but haven’t been placed on programme will be contacted by LWTC who will offer to transfer the patient to ICS Health & Wellbeing. Any patients that decline the transfer to ICS Health & Wellbeing will be discharged back to their practice. Those patients that have been referred to LWTC and placed on a LWTC programme will continue to complete the programme with LWTC.

*Please see this patient transition support guide for GP Practice further information.

Newly-diagnosed patients
Management Referral to be made following a HbA1c or fasting plasma glucose result indicating non-diabetic hyperglycaemia (42 – 47 mmol/mol or 5.5 – 6.9 mmols/L, respectively).

Eligible patients are to be offered a referral onto their local NDPP service within 1 month of their blood result via electronic referral form or invitation letter. Before sending the referral form to consent needs to be received from patient (see patient consent section in form).

*Referral following face-to-face clinical engagement has been proven to result in a much higher patient uptake of the service and is advised where manageable.*

Exclusion criteria:

  • Patients with previous diagnosis of diabetes
  • Under the age of 18 years
  • Gestational diabetes mellitus
  • Pregnancy
  • People who are end of life or on palliative care

A text message reminder can be sent to the patient 4 weeks after the invitation letter is sent. Please see text message template.

A second text message reminder can be sent to the patient 8 weeks after initial letter.

This ensures every patient is offered 3 opportunities to refer themselves onto the NDPP service.

Retrospective NDH patients:
Practices will be asked to complete retrospective search of patients codes with NDH in the previous 12 months. An Invitation letter will then need to be sent to all of these patients using a mailshot approach. Those patients who are already on or have completed the NDPP programme do not need to be sent a referral letter, unless a healthcare professional believes that it would be beneficial for the patient to attend the programme again.

Alternatively, many practices are opting to re-run their clinical search at the end of every month in order to pick up any newly-diagnosed patients in bulk and either:

  • Having a conversation with the patient to gain verbal consent and sending the electronic referral form to the provider or;
  • Sending the referral letter to these patients (no requirement for consent at this point as the patient must self-refer and no patient info being passed to provider).

*Referral following face-to-face clinical engagement has been proven to result in a much higher patient uptake of the service and is advised where manageable.*

When patients decline NDDP offers:

  1. If the patient does not wish to or cannot attend the face-to-face service then they will be offered the digital service. *This will be offered following triage by ICS Health & Wellbeing.
  2. If the patient declines the face-to-face and digital NDPP offer then they will be discharged back to their GP practice and ICS Health & Wellbeing will inform the practice of the patient’s discussion.
  3. If the patient declines the NDPP service offer then the following should be considered:

Face-to-face Programme:

Step 1. Telephone initial assessment
Step 2. 6 fortnightly group sessions
Step 3. 7 monthly group sessions
Step 4. End of programme review.
* Each session last 90 - 120 minutes depending on the topic covered. A total of 25 hours face-to-face is delivered over 14 sessions.

The programme content is based on: 

  • Eating Well
  • Moving More
  • Taking Charge

* Please see NDPP service document for further information on the face-to-face programme content and structure.

Digital Service:

Step 1. 45 minute initial assessment via telephone
Step 2. Digital coaching
Step 3. 30 minute exit call.
* Please see NDPP service document for further information on the digital service content.

Practices will receive quarterly reports from ICS Health & Wellbeing informing them of their patients’ progress on the programme. ICS health & Wellbeing will also inform practices in the quarterly reports when a patient has drop out of the programme. Supplementary Read codes will also be provided for practices to input into their patients’ medical records.

As per the recommendations NICE Guidance PH38 and Gloucestershire’s Primary Care Offer practices are expected to complete annual HbA1c reviews for patients diagnosed with NDH. Patients should also have their weight and Body Mass Index reviewed annually. This annual review should be offered to all NDH patients irrespective if they have attended the NDPP or not.

This regular glycaemic monitoring not only informs discussions regarding improvements or deterioration and the impact of lifestyle change, but also allows for timely diagnosis of type 2 diabetes if progression has occurred. This will not only ensure general practices are NICE compliant but the early hyperglycaemia and cardiovascular risk factor(s) management has significant impact on patients’ future risk of developing diabetes related complications.

Invite Letters:

Please see the Importing Document Templates guidance for information on how to use within your practice.

Referral Forms:
Generic and system specific referral forms are available here.

Please see the Importing Document Templates guidance for information on how to use within your practice.

For patients:

For GP's:-


Sleepstation is a clinically validated sleep improvement and insomnia course. It is web-based Cognitive Behavioural Therapy for insomnia (CBTi). Delivered entirely online, and carefully tailored to each individual, Sleepstation helps people sleep better and overcome insomnia without medication.7

Sleepstation can effectively resolve both primary and secondary insomnia. Patients waiting for treatment for depression who are also experiencing sleep problems would be good candidates. Sleepstation should be considered as an alternative to referring to a sleep clinic for CBTi. Please be advised, pregnant ladies with pregnancy related sleep issues would not be suitable candidates for this programme.

Please note, the service cannot accept referrals for patients who:

  • Are under 18 years old
  • Are currently engaged with another CBT programme
  • Are currently under the care of a psychiatrist
  • Have epilepsy, bipolar disorder, mania, schizoaffective disorder, a personality disorder
  • Have a history of psychosis/psychotic episode, seizures, PTSD, severe migraine or head injury
  • Have very severe untreated generalised anxiety (this should be addressed first)
  • Have been diagnosed with a circadian rhythm disorder
  • Works variable shifts, shifting between day and night regularly
  • Do not have regular access to the internet

Please follow the resource links below for further information:

Translation and Interpretation Services

Please follow the reource link below for full information on accessing translation and interpreting services.

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