1st Line Physiotherapy

AHP Summit 2014

Rob Goodwin, Clinical Lead Physiotherapist, MSK Clinics Team

Introduction

The drivers

Political

Historical

Evidential

Local

The proposal

The implementati

on

Simon Stevens Chief Executive of the NHS Service pressures are intensifying, and longstanding

problems are not going to disappear overnight. As my predecessor David Nicholson has pointed out, this year is going to be a challenge and 2015/16 even more so. No one person can fix everything that needs fixing – certainly not me. Successfully navigating the next few years is going to take a team effort – involving the biggest team in the biggest effort the NHS has ever seen. (April 2014)

The Political Drivers

Improving general practice- A Call to Action (April 2014) an ageing population, growing co-morbidities and increasing

patient expectations, resulting in large increase in consultations, especially for older patients, e.g. 95% growth in consultation rate for people aged 85-89 in ten years up to 2008/09. The number of people with multiple long term conditions set to grow from 1.9 to 2.9 million from 2008 to 2018;

increasing pressure on NHS financial resources, which will intensify further from 2015/16;

growing dissatisfaction with access to services. The most recent GP Patient Survey shows further reductions in satisfaction with access, both for in-hours and out-of-hours services. 76% of patients rate overall experience of making an appointment as good;

persistent inequalities in access and quality of primary care, including twofold variation in GPs and nurses per head of population between more and less deprived areas;

growing reports of workforce pressures including recruitment and retention problems.

The Political Drivers

Improving General Practice- A Call to Action (2014) Phase 1 report Better partnerships: a more innovative approach to planning and delivering

services by way of shared learning and ideas Empowering clinicians: ensuring high-quality support for innovation and

improvement, developing networks to allow more rapid spread of innovation, supporting general practice in developing new models of provision, and releasing time for patient care and service improvement.

The Political Drivers

Previous papers: Healthy Life's, Healthy People; Our

Strategy for Public Health in England (2010) Unleashing innovation and liberating

professional leadership Empowering local leadership and encourage

wider responsibility to improve everyone's health and well-being

The Political Drivers

Previous papers Equality and Excellence; Liberating the

NHS (2010) Moving commissioning to GP’s will mean

redesign and patient pathways is always clinically-led

Autonomy for providers Create the largest and most vibrant social

enterprise sector in the world

The Political Drivers

‘clinical specialists with an extended scope of practice i.e. working beyond the recognised scope of practice of the profession of interest in innovative or non-traditional roles’.

Advanced roles

Drivers associated with ‘modernisation’ Service redesign, staff and skill shortages, new

health care technologies, improvements in quality, cost containment

Professional aspirations Increased job satisfaction, autonomy in

practice, role and career development

Advanced roles

Nursing

AHP’s Meeting the Challenge- A

Strategy for the Allied Health Professions (2000)

Advanced roles

However, the role of the allied health professions has too often been undervalued or neglected. The Government is committed to changing this. The NHS Plan already sets out clear commitments to these staff, in particular that there will be, by 2004,

over 6,500 more therapists and other health professionals, 4,450 more therapists and other key professional staff being

trained and new therapist consultant posts

And we are committed to expanding the roles which the allied health professions play in health and social care, ensuring they can use their skills flexibly and creatively to the benefit of patients.

Advanced roles

AHP’s

McPherson, K, Kersten, P et al, 2006 A systematic review of evidence about

extended roles for allied health professionals

Evidence for advanced roles

McClellan CM et al, 2006 Effect of an extended scope

physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in a adult emergency department

Pearse EO et al, 2006 The extended scope physiotherapist in

orthopaedic out-patients- an audit

Physiotherapy advanced roles

Reeve S and May s, 2009 Exploration of patient’s perspectives of quality within

an extended scope physiotherapy spinal screening service

Kennedy DM et al, 2010 Patients are satisfied with advanced practice

physiotherapists in a role traditionally performed by orthopaedic surgeons

Bath B and Janzen B, 2011 Patient and referring health care provider satisfaction

with a physiotherapy spinal triage assessment service

Physiotherapy advanced rolesPatient and staff perceptions

Stanthorpe J et al, 2012 Extended scope physiotherapy roles for

orthopaedic outpatients: an update systematic review of the literature

Desmeules F et al, 2012 Advanced practice physiotherapy in

patients with MSK disorders: a systematic review

Physiotherapy advanced rolesSystematic reviews

A local coming together

Perceived local

pressures

Local MSK Physiothera

py development

s

Local relationships

Clinical Leadership

Innovative practice

GP burden

The Proposal

Leverage!

Main cohort >400 patients

56 physiotherapy patients

54 GP patients

Close co-operation meant no extra

appointment for x-rays, blood tests

etc

Significant differences in

patient satisfaction

6% referred to GP due to suspected

‘red flags’

9% returned to see their GP with the same problem

More patients had ‘complete

confidence’ in physiotherapist

than GP Physiotherapy group had better information about disorder and self

care

Physiotherapy group had greater

self-efficacy

Realising the proposal

Com

mission

i

ng

2 GP practices 2 half days clinics Pre-launch training Outcome measures Evaluation

1st Line Physiotherapy20 minute

appointmentsMaximum

capacity of 9 new patients per clinic

EQ 5DCARE Scale

Patient satisfaction

1 month6 months

1 yearQualitative evaluation

1st Line Physiotherapy

Question

s