july 2007 elaine wiltshire, clinical specialist physiotherapist. nspct 1 physio direct north...

July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT

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Physio Direct North Staffordshire PCT

Elaine Wiltshire, MCSP, Dip MDT

Clinical Specialist Physiotherapist.


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Physio Direct

Why was it necessary to change?Why was it necessary to change?Commission for Health Improvement (2003): Complete a clinical effectiveness strategy

appropriate to the needs of the population10 Key Roles for AHP’s, NHS Plan (2003): “…being a first point of contact for patient care”.

Improving Working Lives.

Waiting Lists are too long (NSF) 93 % of Ortho. referrals LBP N.Staffs

inappropriate (gov. sub com 2003)

25 % of GP consultations are musculoskeletal in nature.

88% people would rather self refer to physio (YouGov 2003)


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Physio Direct Access ServiceNew method of service deliveryNeeded to look at other

methods of delivery of service due to very high waiting lists, high DNA rates in many Physio Depts.

Already being used in other areas of the UK (Huntingdon, Cheltenham, Northallerton and many more NHS Trusts)


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Physio Direct Access ServiceService commenced September

2005 in Staffordshire Moorlands

PCT

Initially only with one GP Practice

Serving all 16 GP Practices in the

PCT by early July 2006

Patient Population of 120,000


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Physio Direct

How does it work here?

GP recommended (or from within the Practice) or Self –referred.

No written referrals from GP for this population of musculoskeletal out-patients


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Physio Direct Access Service Which Patient Population does this serve?Which Patient Population does this serve? - Musculo-skeletal patients onlyMusculo-skeletal patients only - Over 16 years old - Able to talk to NHS Physiotherapist on

the phone Any Exclusions?Any Exclusions? - Non Musculo-skeletal problem - Under 16 years old - Deaf or difficulty with English language - No Third Party callers (must be the patient) - Patients who need Domiciliary visit by

Physio


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Physio Direct Access ServiceAll are Senior Physiotherapists

(Band 6 or above) on the phone lines

Additional training for the physiotherapist

Each do 1-3 sessions per week1 Session = 2 hoursRemaining time is spent in their

usual work place. (essential so skills are maintained)


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Physio Direct Access ServiceGP recommendation and self-referral

to the serviceAverage call length = 20minsAverage number of calls per day = 20-

25Open from 8.30am - 4.30pm Mon-Fri2 phone lines open Answering Machine takes calls if both

lines are busy then we call the Patient back (usually same day or within 24hours)


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Physio Direct Access Service

Physiotherapy Assessment is done on the Physiotherapy Assessment is done on the TelephoneTelephone

Options following Triage: *Advice Only (advice sheet sent to patient) *Advice and Exercises (written materials sent) *Out-Patient Physio Appt. (made by the

Physio) *Advised to see GP/A&E/Other *Pt may choose not to do the telephone triage

so put on the routine waiting list for Physio Appt.


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3

7

12

18 18

24

30 30

0

5

10

15

20

25

30

35

Number of 2 Hour Sessions per Week

Sep-05Dec-05Mar-06Jun-06Sep-06Dec-06Mar-07Jun-07Linear (Sep-05)


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6 9

5570

82

55

80 88

0

20

40

60

80

100

Number of Calls per Week

Average number of calls per week

Sep-05

Dec-05

Mar-06

J un-06

Sep-06

Dec-06

Mar-07

J un-07


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98.57%

0.78% 0.65%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Percentage of Patients who go through Triage

% who go throughtriage

% refusal

% inappropriate


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AdviceOnly

Advice andExercise

DCOPPhysio

DCGP

3%

77%

20%

0%

20%

40%

60%

80%

Outcome of Initial Phone call

Advice Only

Advice and E xercise

DCOP Physio

DCGP


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Physio Direct Access Service Total number of

calls since Sept 2005 = 6000+

98% of calls go through Triage

20% of callers are referred to Out-Patient Dept

Average telephone call length = 20mins

(Out-Patient Appt, new assessment = 40 mins)


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Do we pick up Red Flags?

Yes; Percent of patients

with 4 Red Flags in Red Flag Hierarchy = 0.9%


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Impact on Physio ServicesWaiting Lists; Rates of DNA; Students;


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Physio Direct Access ServiceWaiting Lists.Significantly reduced;Sept 2005 waiting lists of 30+

weeksCurrently 2-3 weeks on average,

some physio depts have no waiting list.

(This is in spite of job vacancies/frozen posts)


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Physio Direct Access ServiceDNA ratesSignificantly reduced, was 30-

40% in some locations. Now consistently less than 10% (Many locations it is 0)


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Physio Direct Access ServiceStudents; Some difficulty finding

placements due to different patient complexity coming to the Dept. Many simple cases are managed on phone only.


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Physio Direct Access ServiceCostsNeed headsetsPhone-linesPhysiotherapists (X10, not

WTE, to cover our sessions)Admin help (X 2WTE)


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Physio Direct Access ServiceDifficultiesResistance to change by some

staffStudents, harder to provide

places for students as the patients seen in Dept are more complex, and students can only observe telephone sessions, not provide.


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Physio Direct Access ServiceAchievementsImproved patient access to

physiotherapyReduced waiting timesAllows patients to self-referOffers timely advice including

exercises and education to help with early recovery

Improved communication with GP’s about physiotherapy management for their patients


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Plans for Future Expansion of Physio Direct Service into Newcastle (North

Staffordshire PCT) ? Link in to Interface Clinics (Primary Secondary Care)

july 2007 elaine wiltshire, clinical specialist physiotherapist. nspct 1 physio direct north...

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