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Title:

PHYSIO DIRECT

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physio direct jill gamlin - consultant physiotherapist kathy duffield - senior i physiotherapist – PowerPoint PPT presentation

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Date added: 5 December 2019
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Title: PHYSIO DIRECT


1
PHYSIO DIRECT
  • JILL GAMLIN - CONSULTANT PHYSIOTHERAPIST
  • KATHY DUFFIELD - SENIOR I PHYSIOTHERAPIST

2
Catalysts for change..
Personal Dissatisfaction
Patient Dissatisfaction
Time to Think
Right Time....Right Place
3
Patient dissatisfaction
  • Delayed referral, patients problems become more
    chronic, more difficult to resolve, poorer
    outcome of treatment
  • Research evidence - early intervention, aids
    patient recovery
  • Current patient pathway through the system had
    bottlenecks and wasted patients time
  • Frustration for all those involved

4
Previous Patient Pathway
Patient
Hospital Consultant
GP
Discharge
NSAID and or Analgesia
Not Resolved
Physiotherapy 2/52-6/52 to triage
Not Resolved
Physiotherapy extended scope practitioner
Consultant Physiotherapist
5
Time to think
  • Stuck in a traffic jam, chance comment Radio 4 -
    GPs used as inappropriate gate keepers for the
    NHS
  • Why not let patients access physiotherapy
    directly if they think we can help them?
  • Requires a new approach to assessment and
    management.
  • NHS Direct why not Physio Direct?

6
Right environment
  • Line manager excited and receptive to new ideas
  • Dissatisfaction with the present, willingness to
    change
  • PCT management ready to facilitate and support
    the change process financially and with key
    personnel

7
Key Objectives
  • Improve access and capacity for physiotherapy to
    ensure early identification and management of
    problems
  • Empowerment of individuals to take control thus
    reducing chronic pain
  • Pathway redesign reducing GP time dealing with
    M/S problems, ensuring appropriate referral to
    secondary care

8
Process of project development
  • Early involvement of key players - PT team, head
    of primary care, IT, GPs, practice managers,
    patients, pharmacy, PEC
  • Clear vision - good communication, focus on
    improving patient-centred care
  • Open approach to problem solving, can do
    philosophy, negotiation
  • Attention to risk management, clinical governance

9
Project development
  • Reflective learning to capture problems and
    solutions and to carry learning forward
  • Strong leadership to find solutions rather than
    allowing derailment. Conviction, determination,
    confidence that the direction is right
  • Seeking advice from wherever is necessary to
    resolve the next problem

10
Project details
  • 2 GP practices involved representing 23,000
    patients
  • 1 practice enthusiastic and innovative, the other
    had longstanding problems with access
  • Initially a 6 month project which started Nov 01
    with 15,000 funding for 1 WTE senior I PT

11
How it works
  • Dedicated phone line open 8.30am-12.30pm Mondays
    to Fridays excluding BH
  • Computerised screening tool patient details,
    different screens for problems such as LBP, neck,
    thoracic spine, peripheral joints
  • Decision made re diagnosis, advice sheets sent by
    post that day

12
How it works
  • If unable to make a sound clinical decision or
    problems with patient comprehension appointment
    to be seen by PT
  • Inappropriate for PT d/w Consultant PT re
    further investigations/management including ref
    onto other Consultants, suspected fracture ref
    AE
  • Same day information to GP re consultation,
    advice sent to patient with clear instructions to
    call PT Direct back if not resolving

13
How it works
  • Training by Pharmacy to PT to ensure safe advice
    re OTC medication
  • Prescription faxed request to GP for
    prescription for patient to collect if in
    agreement
  • Agreement for PT to request sick certificate for
    2 weeks without GP appointment

14
Referral Pathways
Patient
Physio Direct
GP
Orthopaedic Consultant
Rheumatology Consultant
Extended Scope Practitioner
Consultant Physiotherapist
15
Key aspects - outside the box
  • Different ethos - locus of control passes to
    patient
  • First contact by phone, computerised screening
    tool. Advice sent by post same day
  • Local agreement sick certificates and
    prescriptions
  • Consultant Physiotherapist led service from
    primary to secondary care

16
Outcome of new service
  • 70 of callers managed with telephone advice only
  • Easier access
  • DNA rate for appointments reduced 15 - lt 1
  • Reduced GP appointments for M/S patients
  • Faster access to secondary care consultants when
    required.

17
Audit
  • 100 patients selected randomly, 63 returned
  • Of the 63, 36 received advice exercise sheets
    only, 27 advice at least 1 appointment
  • Figures given are for both groups added together
  • 31 rated service as excellent, 20 good, 9
    average, 1 below average, 1 poor, 1 no comment
  • Positive comments made by both groups regarding
    access, time saved and quality of the service

18
Patient comments
  • The prompt and direct service received can be
    followed with confidence in the knowledge it
    comes from those best qualified to give it .
    This much needed and valued service should
    continue
  • Some more negative comments, difficulty
    understanding exercises from the sheet, opening
    times not convenient, time taken to go through
    questions, already doing exercises so no help

19
Outcome
  • 15 resolved completely
  • 33 improved but not resolved
  • 7 not helped
  • 14 of the not resolved group contacted PT direct
    again
  • Some still receiving treatment
  • 6 went back to the GP

20
Future use of the service
  • 56 would use the service again, 4 would not
  • 57 would recommend the service to others, 4
    might, 2 would not these were in the advice
    only group
  • 1 letter of complaint related to the title of the
    exercise sheet, resolved with one appointment

21
GP audit results
  • Overall happy, one surgery felt consultations
    were quicker, patients dont come back to chase
    PT appointment
  • Helps patients to be proactive
  • Improved communications PT and GP
  • Improved access for Orthopaedic opinion
  • Allows patients to decide whether they will
    pursue PT
  • Helps prevent chronicity

22
PT audit results
  • All 5 PTs commented on the speed of access, more
    patient control, patients dont have to pay for
    the car park or leave work
  • Problems communication with GPs, patients
    returning to GP rather than staying with the
    service
  • Access to consultant PT
  • Stressful coping with the additional work as
    not now able to ref back to GP

23
PT audit results
  • The whole experience of PT direct has improved
    my assessment skills, it has however been harder
    work due to the higher levels of complex
    patients. I have also needed more time for
    communication with GPs.

24
Future developments
  • Roll out to St Neots Nov 03, St Ives ? Jan 04,
    other GP surgeries ? March 04
  • Extension of opening of telephone line ?8.00am
    early evening, ? Saturdays
  • Advertising and promotion, education of users and
    GPs
  • Research funded by professional body
  • Interest from the StHA roll out to rest of region
  • Part of DOH project group - role of AHPs in
    moving work from secondary to primary care

25
Future Development of Physio Direct Patient
Pathway (end of 2003/early 2004)
Patient
Discharge
GP
Physio Direct
PCT Orthopaedic Panel
Physiotherapy Extended Scope Practitioner
Hospital Consultant
Consultant Physiotherapist
26
The last word from the patient..
  • This service encouraged me to seek advice,
    which otherwise I would not have done. I intend
    to seek advice again on another problem this I
    would not do if I had to visit the doctor. To
    the likes of me this service is invaluable.
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