Direct Access Physiotherapy: Challenges and Benefits of a UK Model

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1 Dobrodosli Direct Access Physiotherapy: Challenges and Benefits of a UK Model Bradley Scanes MSc BSc (Hons) PGcert Chartered Physiotherapist (CSP, HCPC & ACPSEM Member)

2 Kdo Sem Who Am I? A physio NHS Football Private Practice Basketball Chartered Society of Physiotherapy Physiobrad

3 Preteklost What used to happen?

4 Bolnik This is Frank Frank woke up this morning with back pain

5 Preteklost Frank would call his General Practice Doctor (GP) and get an appointment

6 Preteklost The GP would see Frank They might give some advice They might give some pain relief They might refer for further investigations They might refer for orthopaedics They might refer for physiotherapy

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8 Preteklost Frank called for his second consultation with the GP Medication and advice did not work

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11 Preteklost PHYSIO ORTHO

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

13 Prisoten So What Happens Now?

14 Prisoten This is Frank Frank woke up this morning with back pain

15 Prisoten Cancer

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

25 Prisoten Assessed Reassured Rehabilitation Started Referred On If Needed

26 Prisoten Direct Access Physio Injury Self referral to Musculoskeletal Physiotherapy Good knowledge of biopsychosocial model and addressing yellow flags Ability to assess and screen for red flags Ability to request x-rays, write sick notes Ability to perform injections Expert knowledge of exercise and rehabilitation Keen on optimising 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

27 Zakaj The Differences? The Patient sees a healthcare professional / General Practice Doctor who is not a specialist in Musculoskeletal Care BMC (2005) Chatterjee et al (2017) The Patient has unnecessary investigations The Patient has multiple appointments vs one

28 Zakaj The Differences? The Patient sees a healthcare professional / General Practice Doctor who is not a specialist in Musculoskeletal Care BMC (2005) Chatterjee et al (2017) The Patient has unnecessary investigations The Patient has multiple appointments vs one

29 Zakaj Direct Access Physio - Why? Increased demand on GP s without growth in resources (Health Committee Select - Primary Care, 2016) 25% reduction in NHS funding for GP practices on past few years (Briggs, 2015) 12% GP training places unfilled (National Audit Office, 2015) 11% of patients failed to get an appointment in 2015 due to demand exceeding capacity (RCGP, 2015). 27% avoidance contacts (NAO, 2015). 40% of GPs working week spent on tasks such as prescriptions, referrals and from filling (Sky News ) 1 in 3 GP consultations are MSK (BOA)

30 Zakaj Suffolk 164 patients 151 Physiotherapy Direct Access Physio - Success? 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

31 Zakaj North Wales Direct Access Physio - More Success? 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 for usual GP care to for physiotherapy care in primary care

32 Zakaj Self-Referral - Why? 10 years ago A cohort of patients get little benefit from appointment with General Practitioner Started as a telephone triage Too busy!! 30 minutes to process referral 3.7 days to get back to people 2010 Technology embraced!!

33 Zakaj 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

34 Zakaj Self-Referral - Success? 80% of patients access our service via the web portal GP hands patient a card Takes patients an average of 15 minutes Telephony team to take information if patients don t have access to internet All referrals triaged within 24 hours 3 minutes to Triage Early Signposting Early Intervention Saves 0.8 of a follow up appointment 97% Friends and Family Score

35 Oprosti Versus

36 Združeno kraljestvo The UK NHS 1948 Free at the point of care 1977 UK Physiotherapists have been able to act as 1st contact practitioners Self referral trial Over last 15 years the physio s role as changed Evidenced based

37 Združeno kraljestvo Assess, diagnose and Treat Triage patients Request Investigations Diagnostic ultrasound imaging Prescribe Inject Run outpatient follow up clinics Scope Of Practice - The UK Physio

38 Koristi Benefits Fewer healthcare interventions for patients Streamlines pathway of care Less time of work Improved autonomy Improved satisfaction Cost effective Saves GP and GP admin staff time Lower prescribing and investigation rates Less referrals sent to secondary care / orthopaedics

39 In depth consultation in a relaxed and unhurried way. Constructive advice for self-help and management for living with arthritis. I was hoping for some massage rather than exercises to do. Benefits - Patients thoughts This service should continue to be offered for all patients Koristi Self referral is a good idea. I hope it continues. I was very pleased at the speed my self referral was dealt with. Cost effective in Most appreciative of terms of my time and personal exercise commitments. programme given to me and explained. Holdsworth and Webster 2006

40 Skrbi Concerns Royal College of General Practitioners warn that making self-referrals the standard for physiotherapy treatment could have the unintended consequence of swamping physiotherapy services Red Flags

41 Izzivi Challenges Deciding logistics Getting all the players on board Agreeing the pathway with the GP practices and consultants Setting parameters with the reception staff Agreeing new ways of working with physios

42 Izzivi Challenges If Do Not Physiotherapists overtaken Loss of autonomy Deskilling

43 Storitev Delivering A Quality Service: What Does It Need Autonomy and accountability Safe and effective Partnership Engagement Learning and development Consent Information governance Communication Evaluation

44 Hvala Direct Access Physiotherapy Direct access and self referral to Physiotherapy works Benefits patients, services and finances Concerns not physiobrad