direct access physiotherapy: challenges and benefits … · dobrodosli. [email protected]....

https://bscanesconsult.com/

Dobrodosli

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Direct Access Physiotherapy:

Challenges and Benefits of a UK Model

Bradley Scanes MSc BSc (Hons) PGcert

Chartered Physiotherapist (CSP, HCPC & ACPSEM Member)

mailto:[email protected]


Kdo Sem

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Who Am I?

•A physio•NHS•Football•Private Practice•Basketball•Chartered Society of Physiotherapy•Consultancy

@bscanes

Physiobrad



Preteklost

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What used to happen?



Bolnik

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This is Frank Frank woke up this morning with back pain



Preteklost

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•Frank would call hisGeneral Practice Doctor(GP) and get anappointment



Preteklost

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•The GP would seeFrank

•They might givesome advice

•They might givesome pain relief

•They might refer forfurther investigations

•They might refer fororthopaedics

•They might refer forphysiotherapy



Preteklost

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Preteklost

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•Frank called for hissecond consultation withthe GP

•Medication and advicedid not work



Preteklost

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Preteklost

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PHYSIO

ORTHO



Preteklost

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What Used To Happen?

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



Prisoten

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So What Happens Now?



Prisoten

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This is Frank Frank woke up this morning with back pain


https://bscanesconsult.com/[email protected]

Cancer

Prisoten



Prisoten



Prisoten

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Are you hurt, injured or ill?

Would you like to see a

physio?

Prisoten



Prisoten

Assessed

Reassured

Rehabilitation Started

Referred On If Needed



Prisoten

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Direct Access PhysioInjury

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 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

Good knowledge of biopsychosocial model and addressing yellow flags



Zakaj

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The Differences?

•The Patient sees a healthcare professional / General Practice Doctor who is not aspecialist in Musculoskeletal Care

•BMC (2005)•Chatterjee et al (2017)

•The Patient has unnecessary investigations•The Patient has multiple appointments vs one



Zakaj

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Direct Access Physio -Why?

•Increased demand on GP’s without growth in resources (Health CommitteeSelect - 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 exceedingcapacity (RCGP, 2015). 27% avoidance contacts (NAO, 2015).

•40% of GPs’ working week spent on tasks such as prescriptions, referrals and fromfilling (Sky News 21.4.16)

•1 in 3 GP consultations are MSK (BOA)



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 waseasily accessible

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



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 physiotherapycare in primary care



Zakaj

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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!!



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



Zakaj

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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



Oprosti

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Versus



Združeno kraljestvo

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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 2003-2005•Over last 15 years the physio’s role as changed•Evidenced based



Združeno kraljestvo

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Scope Of Practice - The UK Physio

•Assess, diagnose and Treat•Triage patients•Request Investigations•Diagnostic ultrasound imaging•Prescribe•Inject•Run outpatient follow up clinics



Koristi

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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



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 selfreferral was dealt

with.

Most appreciative of “personal exercise

programme” given to me and explained. Holdsworth and Webster 2006



Skrbi

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Concerns

•Royal College of General Practitioners warn that making self-referrals thestandard for physiotherapy treatment could have the unintended consequenceof swamping physiotherapy services

•Red Flags



Izzivi

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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



Izzivi

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Challenges If Do Not

•Physiotherapists overtaken•Loss of autonomy•Deskilling



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



Hvala

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Direct Access Physiotherapy

•Direct access and self referral to Physiotherapy works•Benefits patients, services and finances•Concerns not proven

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@bscanes

physiobrad



direct access physiotherapy: challenges and benefits … · dobrodosli. [email protected]....

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