Physio Direct North Staffordshire PCT

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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?
• Commission for Health Improvement (2003)
• Complete a clinical effectiveness strategy
  appropriate to the needs of the population
• 10 Key Roles for AHPs, 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 Service

• New method of service delivery
• Needed 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 Service

• Service 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?
• - Musculo-skeletal patients only
• - Over 16 years old
• - Able to talk to NHS Physiotherapist on
  the phone
• 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 Service

• All are Senior Physiotherapists (Band 6 or above)
  on the phone lines
• Additional training for the physiotherapist
• Each do 1-3 sessions per week
• 1 Session 2 hours
• Remaining time is spent in their usual work
  place. (essential so skills are maintained)

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Physio Direct Access Service

• GP recommendation and self-referral to the
  service
• Average call length 20mins
• Average number of calls per day 20-25
• Open from 8.30am - 4.30pm Mon-Fri
• 2 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 Telephone
• 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/AE/Other
• Pt may choose not to do the telephone triage
  so put on the routine waiting list for Physio
  Appt.

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Physio Direct Access Service
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Physio Direct Access Service
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Physio Direct Access Service
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Physio Direct Access Service
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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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Physio Direct Access Service

• Do we pick up Red Flags?
• Yes
• Percent of patients with 4 Red Flags in Red
  Flag Hierarchy 0.9

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Physio Direct Access Service

• Impact on Physio Services
• Waiting Lists
• Rates of DNA
• Students

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Physio Direct Access Service

• Waiting Lists.
• Significantly reduced
• Sept 2005 waiting lists of 30 weeks
• Currently 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 Service

• DNA rates
• Significantly reduced, was 30-40 in some
  locations. Now consistently less than 10 (Many
  locations it is 0)

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Physio Direct Access Service

• Students
• 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 Service

• Costs
• Need headsets
• Phone-lines
• Physiotherapists (X10, not WTE, to cover our
  sessions)
• Admin help (X 2WTE)

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Physio Direct Access Service

• Difficulties
• Resistance to change by some staff
• Students, 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 Service

• Achievements
• Improved patient access to physiotherapy
• Reduced waiting times
• Allows patients to self-refer
• Offers timely advice including exercises and
  education to help with early recovery
• Improved communication with GPs about
  physiotherapy management for their patients

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Physio Direct Access Service

• Plans for Future
• Expansion of Physio Direct Service into
  Newcastle (North Staffordshire PCT)
• ? Link in to Interface Clinics
• (Primary ? Secondary Care)