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Self Referral

Self Referral. Julie Shepherd Lead Physiotherapist. Overview of presentation. History & evolution of local self referral scheme Benefits Implementation Evaluation The Future!. Key points regarding Self Referral. Does not open the floodgates

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Self Referral

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  1. Self Referral Julie Shepherd Lead Physiotherapist

  2. Overview of presentation • History & evolution of local self referral scheme • Benefits • Implementation • Evaluation • The Future!

  3. Key points regarding Self Referral • Does not open the floodgates • Is patient centred & encourages self management/empowerment • Enables timely access to advice/reducing chronicity • Can prevent people going off work/get them back to work • Enhances therapists autonomy & management strategies • Can increase capacity by reducing new to follow up ratios • Saves GP time • Can support long term conditions

  4. Physiotherapy Outpatient new attendances

  5. Local implementation milestones • 1991 - Established in East Gloucestershire Trust, stopped with the introduction of GP Fundholding in 1995 & then re-established in 1998 with the demise of GP Fundholding & the emergence of Primary Care Groups • 2000 – Staff self referral at Cheltenham General Hospital • 2001 – ‘Physio Direct’ telephone access • 2010 – ‘Drop in’ clinics

  6. Staff Self Referral • 341 patients seen in the first year (2000) • New to follow up ratio 1: 1.4 compared to department average of 1: 3.4 • Anecdotally – patients more self motivated & happy to self manage • Commended by a Health & Social Care Award 2001 “Improving the lives of staff” category

  7. ‘Physio Direct’ • A ‘trial’ which commenced in November 2001 with 3 GP practices (1 hour per day, Mon-Fri) • Extended in 2002 (3.5 hours per day) to cover 6 practices in total (population of 53,000) • Extended in 2005 to cover all GP practices within Cheltenham (from 9.00am to 4pm)

  8. Key Objectives • Provide telephone access to people to ensure timely advice/intervention is given • Empower people to self manage their condition • Provide a new service within existing resources • Demonstrate that demand and capacity can be managed in a different way • Reduce administration and save time for GPs

  9. The Pathway • The patient can self refer via the telephone following the process outlined on posters or in the GP newsletter. • Alternatively if the GP feels that his/her patient requires physiotherapy, the GP tells the patient to contact Physio Direct. • The patient phones the physiotherapy department at the designated times to speak to a Physiotherapist.

  10. The Pathway • Assessment by asking a series of questions, leads to one of the following outcomes for the patient: • Advice including an exercise sheet (post or e-mail) and/or information leaflet or • An appointment to see the physiotherapist or • Referral to their GP if a medical assessment is indicated.

  11. How the scheme was managed • All parties agreeing clear objectives and measures • Involvement of all staff delivering the service from the outset • Working with PCT “Access” leads and GPs • Making changes as needed and testing to ensure added value • Starting small and building a system based on measured success • Evaluation and feedback to all involved

  12. ‘Red Flags’ In the first year, 3 patients were fast tracked with the following problems: • Pathological fracture of C7 • Fractured pubic ramus • Child with an avulsion fracture

  13. Evaluation • Questionnaire surveys were sent to participating GPs and patients who had been managed by Physio Direct and had been discharged from the service at 3 months and 14 months. • A response rate of 92% and 64% (3 months), 87% and 58% (14 months) respectively was achieved. Of the sample of patients surveyed: • 71% of patients reported that they felt more in control of their symptoms • 69% of patients had not consulted elsewhere • 88% felt that the service should continue

  14. Analysis of the activity data Nov 2001-Dec 2002: 820 patients called Physio Direct • 40% of those were managed with advice and exercise sheets/information leaflets only • 60% of those visited the local Physiotherapy Department for follow up intervention. Of those, 25% needed only one follow up appointment • The average wait for routine referrals to the department remained consistent at 7 weeks

  15. Comments from service users • “An easy quick way to have minor problems solved” • “Excellent way of getting quick advice. I have previously had to wait weeks for an appointment. I spoke to a friendly physio who listened and gave me unhurried time. I needed reassurance and was told I could phone again and be seen if necessary and speak to the same person”

  16. Comments from service users • “I was very pleased with the service given. The only piece of information I didn’t get was when to stop the exercises” • “Most of this is not relevant to me, as the physio, hearing of my problem took me to A&E where a crack in the bone was discovered. I was impressed with the system. Many thanks to the physio concerned”

  17. Comments from service users • “Physio triumphed where my doctor failed to diagnose and treat” • “The immediacy of consultation and advice was a tremendous improvement on previous referrals to physio with the traditional long wait for treatment/advice” • “Reassurance and professional pain management helped alleviate the stress and anxiety and prevented non-useful visits to the GP”

  18. Comments from service users • “It took some 5 hours on the phone, over 2 weeks to at last get in touch with the Physio” • “I feel that it is necessary for the Physio to have a diagnosis of the problem, either from the GP or Consultant”

  19. Comments from GPs • “Patients very happy with the service and I have had very good reports from those using it. Saves an enormous amount of time in admin and unnecessary referrals to yourselves. Thank you” • “The scheme seems to be working well. I have had positive feedback from patients, both from those that get advice and leaflets in the post and those who get appointments”

  20. Comments from GPs • “Of great assistance and simpler than direct booking which wasted staff time” • “Very helpful service P.S. good questionnaire – short brief and to the point” • “Excellent++++” • “Greatly reduced admin, so please continue”

  21. Current methods supporting self referral • Telephone eg ‘Physio Direct’ & follow up consultations • ‘Paper’ Self referral form (including pre-assessment form) • On line referral: Re-vamped website • ‘Drop in’ clinics

  22. Learning through implementing Self Referral • Does not open the floodgates • Enables timely access to advice/reducing chronicity • Can prevent people going off work/get them back to work • Is patient centred & encourages self management/empowerment • Enhances therapists autonomy & professional responsibility • Can reduce DNA rates and new to follow up ratios • Saves GP time • Can support long term conditions • Gives confidence to take on new ways of working – development of ‘drop in’ clinics

  23. What you need: • Passion for change & to take a ‘risk’ • Staff involvement from the outset in planning & implementation • Self management philosophy • GPs on side • Start small and build in ‘bite size’ chunks • Tailor it in regard to your population & feedback • Other helpful resources - Self Referral Implementation tools: www.csp.org.uk

  24. The future? Increased usage of technology to communicate with patients • e-mail • ?SKYPE • ?Twitter • ?Blogs

  25. References • Holdsworth LK, Webster VS, McFadyen AK, et al. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy. 2007;93(1): • Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008. p 9 • Chartered Society of Physiotherapy. Proceedings of Council: byelaw amendments. Physiotherapy. 1978;64(7):218. • Department of Health. The NHS in England: The operating framework for 2009/10. London: Department of Health; 2009. • Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008. • Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008. p 15 • Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008. p 16 • Black C. Working for a healthier tomorrow. Dame Carol Black's review of the health of Britain's working age population. London: TSO; 2008. p 76 • Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008. p 18.URL: • Department of Health. The patient's charter. London: Department of Health; 1991. • Holdsworth LK, Webster VS, McFayden AK. Direct access to physiotherapy in primary care now and into the future. Physiotherapy. 2004;90(2):64-72. • Department of Health. The NHS in England: The operating framework for 2009/10. London: Department of Health; 2009. p 16 • Department of Health. The NHS in England: The operating framework for 2009/10. London: Department of Health; 2009. p 13 • Black C. Working for a healthier tomorrow. Dame Carol Black's review of the health of Britain's working age population. London: TSO; 2008. p 76 • Darzi A. High quality care for all: NHS Next Stage Review final report. Cmd 7432. London: Department of Health; 2008. • Scottish Executive Health Department. Building on success: Future directions for allied health professions in Scotland. Edinburgh: Scottish Executive; 2002. • NHS Scotland. Better health, better care: action plan. Edinburgh: NHS Scotland; 2007. • Scottish Executive. Co-ordinated, integrated and fit for purpose: a delivery framework for adult rehabilitation in Scotland. Edinburgh: Scottish Executive; 2007. • Sturgeon N. Scottish parliamentary questions: written answers Tuesday 3 November 2009 Edinburgh: Scottish Parliament; 2009. • NHS Lothian. NHS Lothian at the cutting edge (press release). Edinburgh: NHS Lothian; 2009. • Welsh Assembly Government. A therapy strategy for Wales: the contribution of therapy services to transforming the delivery of health and social care in Wales. Therapies for modernisation. Cardiff: Welsh Assembly Government; 2006. p 5 • Bookmark/Search this post with:

  26. "If you always do what you've always done, you'll always get what you've always got."For further information please contact:julie.shepherd@glos.nhs.uk

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