Direct Access Physiotherapy: Challenges and Benefits of a UK Model - - PowerPoint PPT Presentation

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Dobrodosli

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Direct Access Physiotherapy: Challenges and Benefits

• f a UK Model

Bradley Scanes

MSc BSc (Hons) PGcert Chartered Physiotherapist (CSP, HCPC & ACPSEM Member)

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Kdo Sem

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Who Am I?

• A physio
• NHS
• F
• o tb a ll
• Priva te Pra c tic e
• Ba ske tb a ll
• Cha rte re d So c ie ty o f Physio the ra py
• Co nsulta nc y

@ b sc a ne s Physio b ra d

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Preteklost

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What used to happen?

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Bolnik

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This is Frank Frank woke up this morning with back pain

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Preteklost

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• F

ra nk wo uld c a ll his Ge ne ra l Pra c tic e Do c to r (GP) a nd g e t a n a ppo intme nt

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Preteklost

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• T

he GP wo uld se e F ra nk

• T

he y mig ht g ive so me a dvic e

• T

he y mig ht g ive so me pa in re lie f

• T

he y mig ht re fe r fo r furthe r inve stig a tio ns

• T

he y mig ht re fe r fo r

• rtho pa e dic s
• T

he y mig ht re fe r fo r physio the ra py

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Preteklost

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Preteklost

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• F

ra nk c a lle d fo r his se c o nd c o nsulta tio n with the GP

• Me dic a tio n

a nd a dvic e did no t wo rk

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Preteklost

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Preteklost

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Preteklost

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PHYSIO ORTHO

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Preteklost

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Wha t Use d T

• Ha ppe n?

Soft tissue Injury Attempt to self manage Presents in *GP surgery 1st time Direct Paper referral to physio via the post Presents in GP surgery 2nd time Referral received in physio department and processed Physio waiting list Physio assessment ? Needs further investigation Orthopaedic specialist * GP = General Practice Doctor

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Prisoten

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So What Happens Now?

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Prisoten

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This is Frank Frank woke up this morning with back pain

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Cancer

Prisoten

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Are you hurt, injured or ill? Would you like to see a physio?

Prisoten

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Prisoten

Assessed Reassured Rehabilitation Started Referred On If Needed

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Prisoten

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Direct Access Physio

Injury Self referral to Musculoskeletal Physiotherapy Ability to perform injections Ability to assess and screen for red flags Expert knowledge of exercise and rehabilitation Ability to request x-rays, write sick notes Keen on

• ptimising self

management and promoting healthy living behaviour But able to use other treatment techniques as part of a management plan ie. manipulations, acupuncture if appropriate Good knowledge of biopsychosocial model and addressing yellow flags

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Zakaj

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The Differences?

• T

he Pa tie nt se e s a he a lthc a re pro fe ssio na l / Ge ne ra l Pra c tic e Do c to r who is no t a spe c ia list in Musc ulo ske le ta l Ca re

• BMC (2005)
• Cha tte rje e e t a l (2017)
• T

he Pa tie nt ha s unne c e ssa ry inve stig a tio ns

• T

he Pa tie nt ha s multiple a ppo intme nts vs o ne

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Zakaj

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The Differences?

• T

he Patie nt se e s a he a lthc a re pro fe ssio na l / Ge ne ra l Pra c tic e Do c to r who is no t a

spe c ia list in Musc ulo ske le ta l Ca re

• BMC (2005)
• Cha tte rje e e t a l (2017)
• T

he Patie nt ha s unne c e ssa ry inve stig a tio ns

• T

he Patie nt ha s multiple a ppo intme nts vs o ne

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Zakaj

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Direct Access Physio - Why?

• I

nc re a se d de ma nd o n GP’ s witho ut g ro wth in re so urc e s (He a lth Co mmitte e Se le c t - Prima ry Ca re , 2016)

• 25% re duc tio n in NHS funding fo r GP pra c tic e s o n pa st fe w ye a rs (Brig g s, 2015)
• 12% GP tra ining pla c e s unfille d (Na tio na l Audit Offic e , 2015)
• 11% o f pa tie nts fa ile d to g e t a n a ppo intme nt in 2015 due to de ma nd e xc e e ding

c a pa c ity (RCGP, 2015). 27% a vo ida nc e c o nta c ts (NAO, 2015).

• 40% o f GPs’ wo rking we e k spe nt o n ta sks suc h a s pre sc riptio ns, re fe rra ls a nd fro m

filling (Sky Ne ws 21.4.16)

• 1 in 3 GP c onsultations ar

e MSK (BOA)

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Zakaj

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Direct Access Physio - Success?

Suffolk

• 164 patients
• 151 Physiotherapy
• 1 GP, 1 A&E, 1 Falls Pathway, 2 Podiatry
• 8 Discharged
• 99% Friends and Family Score
• 96% ‘strongly agreed or agreed’ that they were seen quickly and the service was

easily accessible

• 88% ‘Strongly agreed or agreed’ that the service offered was ‘perfect’

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Zakaj

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Direct Access Physio - More Success?

North Wales

• 2 Physios, 1525 patients in first 6 months
• 23 required input from GP
• 12% reduction in referrals to secondary care

Liverpool

• 2 Physios, 2 practices for 1 year
• Statistical improvement in clinical recovery
• Patients reported great confidence in Physiotherapists ability to assess and treat them
• Reduction is case cost from £695.45 for usual GP care to £89.26 for physiotherapy

care in primary care

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Zakaj

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Self-Referral - Why?

• 10 ye a rs a g o
• A c o ho rt o f pa tie nts g e t little b e ne fit fro m a ppo intme nt with Ge ne ra l Pra c titio ne r
• Sta rte d a s a te le pho ne tria g e
• T
• o b usy!!
• 30 minute s to pro c e ss re fe rra l
• 3.7 da ys to g e t b a c k to pe o ple
• 2010 T

e c hno lo g y e mb ra c e d!!

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Zakaj

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Self-Referral - Why?

GP Referral GP Suggested Self Referral

Old style GP letter Patient given or picks up card, patient fills in or calls and referral completed Patient picks up card and completes referral online or on phone

▪

Admin receive form, register, urgency criteria given by physio

▪

Appointment given for urgent where possible, routine onto waiting list

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Zakaj

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Self-Referral - Success?

• 80% o f pa tie nts a c c e ss o ur se rvic e via the we b po rta l
• GP ha nds pa tie nt a c a rd
• T

a ke s pa tie nts a n a ve ra g e o f 15 minute s

• T

e le pho ny te a m to ta ke info rma tio n if pa tie nts do n’ t ha ve a c c e ss to inte rne t

• All re fe rra ls tria g e d within 24 ho urs
• 3 minute s to T

ria g e

• E

a rly Sig npo sting

• E

a rly I nte rve ntio n

• Sa ve s 0.8 o f a fo llo w up a ppo intme nt
• 97% F

rie nds a nd F a mily Sc o re

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Oprosti

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Versus

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Združeno kraljestvo

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The UK

• NHS 1948
• F

re e a t the po int o f c a re

• 1977 UKPhysio the ra pists ha ve b e e n a b le to a c t a s 1st c o nta c t pra c titio ne rs
• Se lf re fe rra l tria l 2003-2005
• Ove rla st 15 ye a rs the physio ’ s ro le a s c ha ng e d
• E

vide nc e d b a se d

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Združeno kraljestvo

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Scope Of Practice - The UK Physio

• Asse ss, dia g no se a nd T

re a t

• T

ria g e pa tie nts

• Re q ue st I

nve stig a tio ns

• Dia g no stic ultra so und ima g ing
• Pre sc rib e
• I

nje c t

• Run o utpa tie nt fo llo w up c linic s

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Koristi

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Benefits

• F

e we rhe a lthc a re inte rve ntio ns fo r pa tie nts

• Stre a mline s pa thwa y o f c a re
• L

e ss time o f wo rk

• I

mpro ve d a uto no my

• I

mpro ve d sa tisfa c tio n

• Co st e ffe c tive
• Sa ve s GP a nd GP a dmin sta ff time
• L
• we r pre sc rib ing a nd inve stig a tio n ra te s
• L

e ss re fe rra ls se nt to se c o nda ry c a re / o rtho pa e dic s

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Koristi

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Benefits - Patients thoughts

In depth consultation in a relaxed and unhurried

• way. Constructive advice

for self-help and management for living with arthritis. This service should continue to be offered for all patients… Self referral is a good idea. I hope it continues. I was hoping for some massage rather than exercises to do. Cost effective in terms of my time and commitments. I was very pleased at the speed my self referral was dealt with. Most appreciative of “personal exercise programme” given to me and explained. Holdsworth and Webster 2006

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Skrbi

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Concerns

• Ro ya l Co lle g e
• f Ge ne ra l Pra c titio ne rs wa rn

tha t ma king se lf-re fe rra ls the sta nda rd fo r physio the ra py tre a tme nt c o uld ha ve the uninte nde d c o nse q ue nc e

• f swa mping physio the ra py se rvic e s
• Re d F

la g s

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Izzivi

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Challenges

• De c iding lo g istic s
• Ge tting a ll the pla ye rs o n b o a rd
• Ag re e ing the pa thwa y with the GP pra c tic e s a nd c o nsulta nts
• Se tting pa ra me te rs with the re c e ptio n sta ff
• Ag re e ing ne w wa ys o f wo rking with physio s

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Izzivi

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Challenges If Do Not

• Physio the ra pists o ve rta ke n
• L
• ss o f a uto no my
• De skilling

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Storitev

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Delivering A Quality Service: What Does It Need

• Autonomy and accountability
• Safe and effective
• Partnership
• Engagement
• Learning and development
• Consent
• Information governance
• Communication
• Evaluation

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Hvala

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Direct Access Physiotherapy

• Dire c t a c c e ss a nd se lf re fe rra l to Physio the ra py wo rks
• Be ne fits pa tie nts, se rvic e s a nd fina nc e s
• Co nc e rns no t pro ve n

brad@bscanesconsult.com @bscanes physiobrad