Download - 1 st Line Physiotherapy AHP Summit 2014 Rob Goodwin, Clinical Lead Physiotherapist, MSK Clinics Team
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