july 2007 elaine wiltshire, clinical specialist physiotherapist. nspct 1 physio direct north...
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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.
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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.
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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Physio Direct Access Service
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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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Physio Direct Access Service
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
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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Physio Direct Access Service
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
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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Physio Direct Access Service
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
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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Physio Direct Access Service
Do we pick up Red Flags?
Yes; Percent of patients
with 4 Red Flags in Red Flag Hierarchy = 0.9%
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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Physio Direct Access Service
Impact on Physio ServicesWaiting Lists; Rates of DNA; Students;
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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.
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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Physio Direct Access ServiceCostsNeed headsetsPhone-linesPhysiotherapists (X10, not
WTE, to cover our sessions)Admin help (X 2WTE)
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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.
July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT
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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