18 Week RTT – MSK Event

1. 18 Week RTT – MSK Event Judith Park, General Manager for Surgical and Critical Care

2. Programme for the Day

3. SELF REFERRAL TO PHYSIOTHERAPY RUTH CURRIE PHYSIOTHERAPY TEAM LEAD

4. BACKGROUND • 2007/8 – Physiotherapy waiting lists across NHS Lanarkshire inequitable. Varying from 3-4 weeks in some sites to 36 weeks in others • NHS L had never introduced self referral to Physiotherapy in any format

5. AIMS • To create equity in waiting times across NHS L • To reduce waiting times for physiotherapy across NHS L • To increase access to Physiotherapy • To offer advice and enable some to self manage their condition

6. THE PILOT PHASE • An 18 month preparatory phase in 2008/9 to reduce waiting times and waiting lists • Temporary staff employed for 18 months • A 6 month trial of the a telephone self referral service to Physiotherapy in 2 locations – Clydesdale (rural) and Motherwell (urban)

7. THE ROLL OUT JANUARY 2010 PHYSIOTHERAPY ASSESSENT LINE (PAL)

8. Monday to Friday 9am – 12 noon Open to all adults who live in Lanarkshire who have a musculo-skeletal problem for which Physiotherapy advice or intervention may be of benefit

9. Patients must be : • Able to communicate via the telephone • Present to give their consent • Be available for assessment within office hours • If not, a GP referral may be more appropriate

10. THE SYSTEM • Telephone system • Computer database • Experienced clinicians

11. TELEPHONE SYSTEM • A single telephone number for every Lanarkshire resident to use • 01236 713901 • Through an English based Telephonetics system • No queuing • A voice mail option • Up to 30 incoming telephone lines

12. COMPUTER BASED SYSTEM • An electronic physiotherapy assessment • Linked in with CHI so demographics can be pulled down for Lanarkshire residents • A clinical based assessment tool • The telephone assessment takes on average 10 – 15 minutes

13. EXPERIENCED CLINICIANS • All band 6 and 7 MSK physiotherapists • Some band 5 Physiotherapists who had at least 2 years MSK experience with sound clinical reasoning skills and well developed communication skills • Over 60 physiotherapists currently involved

14. TRAINING PROGRAMME • 1.5 hour teaching session with PAL manual and introduction to the IT system • A 1.5 hour mock call session • A 1.5 hour supervised call back session Then Go Live!

15. VOICE MAIL • Computer based secure call back site for all voicemails • SLA is to call back those who leave a message within 2 working days • X2 attempts made to reach the patient • Voice message left

16. A TYPICAL DAY • 9am – 12 noon : up to x10 physiotherapists ‘live’ • Each physiotherapist can take between 10 and 15 calls • 1.30pm – 4.30pm : up to 3 physiotherapists on ‘call backs’

18. CALLOUTCOME • Self Manage and Discharge • Routine Appointment • Urgent Appointment • Emergency Referral to A&E • Information only • Advised GP visit • Salus – Health for Employability • Salus – Working Health Services

19. Self Manage and Discharge Option to • Send some simple evidence based exercises for specific joints/ conditions • Direct to evidence based web pages • Information can be sent via email (non reply email address for PAL) • Ask to call back within a specific time period if no or limited improvement

20. Appointed patients • Referral sent electronically to our 26 MSK sites and downloaded daily • Each department follows the same MSK prioritisation criteria • Routine – within 9 weeks • Urgent – within 5 working days

21. Emergency Referral • Any patient who, through the clincial reasoning process, is identified to be suffering from a condition which may require immediate medical attention (eg: cauda equina) Physiotherapist phones ahead to A&E and speaks to the receiving registrar.

22. Information Only • Enquiries regarding uplift or return of equipment, appointment times, referral processes, etc

23. Advised GP visit • To discuss medication / pain control • For a written referral if communication not possible via the telephone • For outcome of investigations

24. Salus – Health For Employability • For those who are unemployed and who have a health condition which may be preventing them from accessing employment or training • A case management approach

25. Salus – Working Health Services • Private Physiotherapy provided for those who are self employed or who work for a small business of less than 250 employees.

26. 2010 Data Incoming calls – 31,488 Calls answered – 12,230 Completed Assessments – 11,688 Referrals to Physiotherapy - 8621

27. 2011 Data to end September Incoming calls – 31,947 Calls answered – 13,751 Completed assessments – 12,814 Referrals to Physiotherapy - 9151

30. DATA FOR PERIOD JANUARY 2010 TO JULY 2011

38. The Benefits of Self Referral to PhysiotherapyPAL

39. Benefits to the Patient • Immediate access to Physiotherapy advice • Experienced clinician with sound clinical reasoning skills • Access to electronic or paper based advice and exercise • An alternative method of referral

40. Benefits to the GP • PAL business cards available in all GP practices • Less time consuming than writing or dictating a written referral • Cost effective • Places the onus on the patient to initiate the referral

41. Benefits to Physiotherapy Service • More accurate information on the referral • Patient usually already commenced some home exercise or advice • A percentage self manage • Reduced inappropriate referrals • Reduced NP : Return patient ratio • Equitable waiting lists and times

42. The Challenges • Answering all our incoming calls • Coping with computer crashes • Staff absence / holidays • Balancing time on telephone assessment with 1:1 patient assessment and treatment

43. The Future • NHS 24 • Janie Thomson