Digitising the NERS in Wales: Lessons in system transformation
Health tech, Healthy Lifestyles
22 September 2026
By Emily
Managing a public health initiative at a national scale brings significant operational challenges. The Welsh National Exercise Referral Scheme (NERS) has been supporting health outcomes for 20 years. Operating across 22 local authority areas, NERS handles over 30,000 referrals annually across 11 health condition pathways. This includes cardiac rehab, cancer prehab/rehab, respiratory conditions, and mental health.
In our webinar, Rhian Pearce (National NERS Coordinator, Public Health Wales) discussed the multi-year project to digitise NERS using Mayden’s flexible patient management platform, Theseus. Read on for key insights, operational shifts, and lessons learned from transforming a paper-based referral process into a digital system.
Catch up with the webinar on demand.
The problem: Fragmented systems and governance risks
Before its digital transformation, NERS relied on a mix of paper forms, Word documents sent via email, and an ageing legacy database:
- Administrative burden. Staff wrote client assessments down on paper during sessions and manually re-typed them into computers later.
- Information governance risks. In-depth, sensitive patient medical data was routinely sent across email inboxes and posted through physical mail.
- Data inconsistencies. Across 22 local areas, 11 different referral forms were in use, making standardised reporting difficult.
- Incomplete data entry. Missing or inaccurate information on paper forms required team members to make repeated phone calls back and forth to referring clinicians before onboarding a patient.
The strategy: Designing a unified patient journey with Theseus
Public Health Wales selected Theseus through formal tender processes to consolidate the entire end-to-end journey into a single digital solution. Therefore, this includes from initial referral through to 16-week completion and evaluation.
Key stages of implementation:
- Process mapping & form rationalisation. The team engaged local coordinators to standardise 11 legacy referral forms into a unified digital structure inside Theseus. Furthermore, this included agreeing on mandatory fields needed to prescribe exercise safely.
- Clinical system integration. The digitised referral form was built to launch directly inside GP clinical software (EMIS). Therefore, this allowed primary care providers to refer patients seamlessly without leaving their core workflow.
- Agile testing. The referral and onboarding modules were built using agile iterations in Theseus, testing forms against local delivery teams to ensure practical usability.
- Mobile worker view. Theseus provides mobile tablet access for the 120 exercise referral professionals on the ground. Practitioners could access the mobile worker view to complete baseline health tests and questionnaires alongside the client in real time.
Key outcomes and operational impact
The Theseus system went live in January 2024, delivering immediate changes across local teams and national oversight:
- Direct admin time savings. Eliminating double-handling of data saved practitioners up to 3 hours of daily administration, therefore, freeing up time to deliver physical activity interventions.
- Reduced drop-out rates. Integrating automated SMS reminders directly through Theseus helped reduce “Did Not Attend” (DNA) rates and optimise team schedules.
- Enhanced transparency. Local coordinators gained real-time visibility into workload distribution, capacity, and waiting lists across leisure centres using national and local platform views.
- Data integration for research. Referral and outcome data captured in Theseus now link via API directly to the SAIL Databank at Swansea University to analyse long-term healthcare utilisation and calculate return on investment (ROI).
Key lessons learned
During the session, Rhian reflected on the operational realities and takeaways from rolling out a large-scale public health project:
- Varying tech literacy. Digital adoption varies widely across a multi-generational workforce. Dedicated training and continuous support are required to ensure consistent system usage.
- Standardising inputs over free text. Allowing open text fields in baseline tests led to inconsistent post-programme outcome tracking. Restricting fields to dropdown menus in Theseus ensured data integrity across 16-week evaluations.
- Managing clinical pushback. Primary care clinicians found long digital forms burdensome. The team adapted by adjusting mandatory fields while balancing the need for safe medical disclosures.
- Technical bridge roles. Projects benefit significantly from having internal technical analysts embedded in the project team to bridge communication between clinical staff and software design teams.
Looking ahead
With the digitised platform now successfully embedded across all 22 local authority areas, Public Health Wales and the Theseus team are turning their attention towards future expansion. Plans are already underway to add new condition-specific care pathways to further broaden the scheme’s reach. By replacing fragmented paper administration with an integrated digital infrastructure, NERS has built a scalable, sustainable model that ensures staff can spend less time behind a keyboard and more time helping people build lifelong health habits.
If you would like to find out more about how Theseus could help your exercise by referral service. get in touch with us.