Dobrodosli Direct Access Physiotherapy: Challenges and Benefits of a UK Model Bradley Scanes MSc BSc (Hons) PGcert Chartered Physiotherapist (CSP, HCPC & ACPSEM Member) https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Kdo Sem Who Am I? •A physio •NHS •F o o tb a ll •Priva te Pra c tic e •Ba ske tb a ll •Cha rte re d So c ie ty o f Physio the ra py •Co nsulta nc y @ b sc a ne s Physio b ra d https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost What used to happen? https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Bolnik This is Frank Frank woke up this morning with back pain https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost •F ra nk wo uld c a ll his Ge ne ra l Pra c tic e Do c to r (GP) a nd g e t a n a ppo intme nt https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost •T he GP wo uld se e F ra nk •T he y mig ht g ive so me a dvic e •T he y mig ht g ive so me pa in re lie f •T he y mig ht re fe r fo r furthe r inve stig a tio ns •T he y mig ht re fe r fo r o rtho pa e dic s •T he y mig ht re fe r fo r physio the ra py https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost •F ra nk c a lle d fo r his se c o nd c o nsulta tio n with the GP •Me dic a tio n a nd a dvic e did no t wo rk https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost PHYSIO ORTHO https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Preteklost Wha t Use d T o Ha ppe n? Soft tissue Injury Attempt to self manage Presents in * GP Presents in GP Direct Paper referral surgery 1 st time surgery 2 nd time to physio via the post * GP = General Practice Doctor Referral received in physio department and processed Physio waiting list Physio assessment ? Needs further Orthopaedic investigation specialist https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten So What Happens Now? https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten This is Frank Frank woke up this morning with back pain https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten Cancer https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten Are you hurt, injured or ill? Would you like to see a physio? https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten Assessed Reassured Rehabilitation Started Referred On If Needed https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Prisoten Direct Access Physio Injury Good knowledge of biopsychosocial model and addressing yellow Self referral to Musculoskeletal flags Physiotherapy Ability to Ability to Expert Keen on assess and perform knowledge of optimising self screen for injections exercise and management red flags rehabilitation and promoting healthy living behaviour Ability to request x-rays, write sick But able to use other treatment techniques as part of notes a management plan ie. manipulations, acupuncture if appropriate https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj The Differences? •T he Pa tie nt se e s a he a lthc a re pro fe ssio na l / Ge ne ra l Pra c tic e Do c to r who is no t a spe c ia list in Musc ulo ske le ta l Ca re •BMC (2005) •Cha tte rje e e t a l (2017) •T he Pa tie nt ha s unne c e ssa ry inve stig a tio ns •T he Pa tie nt ha s multiple a ppo intme nts vs o ne https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj The Differences? • T he Patie nt se e s a he a lthc a re pro fe ssio na l / Ge ne ra l Pra c tic e Do c to r who is no t a spe c ia list in Musc ulo ske le ta l Ca re •BMC (2005) •Cha tte rje e e t a l (2017) • T he Patie nt ha s unne c e ssa ry inve stig a tio ns • T he Patie nt ha s multiple a ppo intme nts vs o ne https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj Direct Access Physio - Why? •I nc re a se d de ma nd o n GP’ s witho ut g ro wth in re so urc e s (He a lth Co mmitte e Se le c t - Prima ry Ca re , 2016) •25% re duc tio n in NHS funding fo r GP pra c tic e s o n pa st fe w ye a rs (Brig g s, 2015) •12% GP tra ining pla c e s unfille d (Na tio na l Audit Offic e , 2015) •11% o f pa tie nts fa ile d to g e t a n a ppo intme nt in 2015 due to de ma nd e xc e e ding c a pa c ity (RCGP, 2015). 27% a vo ida nc e c o nta c ts (NAO, 2015). •40% o f GPs’ wo rking we e k spe nt o n ta sks suc h a s pre sc riptio ns, re fe rra ls a nd fro m filling (Sky Ne ws 21.4.16) • 1 in 3 GP c onsultations ar e MSK (BOA) https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj Direct Access Physio - Success? Suffolk • 164 patients • 151 Physiotherapy • 1 GP, 1 A&E, 1 Falls Pathway, 2 Podiatry • 8 Discharged • 99% Friends and Family Score • 96% ‘strongly agreed or agreed’ that they were seen quickly and the service was easily accessible • 88% ‘Strongly agreed or agreed’ that the service offered was ‘perfect’ https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj Direct Access Physio - More Success? North Wales • 2 Physios, 1525 patients in first 6 months • 23 required input from GP • 12% reduction in referrals to secondary care Liverpool • 2 Physios, 2 practices for 1 year • Statistical improvement in clinical recovery • Patients reported great confidence in Physiotherapists ability to assess and treat them • Reduction is case cost from £695.45 for usual GP care to £89.26 for physiotherapy care in primary care https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj Self-Referral - Why? •10 ye a rs a g o •A c o ho rt o f pa tie nts g e t little b e ne fit fro m a ppo intme nt with Ge ne ra l Pra c titio ne r •Sta rte d a s a te le pho ne tria g e •T o o b usy!! •30 minute s to pro c e ss re fe rra l •3.7 da ys to g e t b a c k to pe o ple •2010 T e c hno lo g y e mb ra c e d!! https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj Self-Referral - Why? GP Referral GP Suggested Self Referral Patient given or picks Patient picks up card Old style GP up card, patient fills and completes letter in or calls and referral online or on referral completed phone ▪ Admin receive form, register, urgency criteria given by physio ▪ Appointment given for urgent where possible, routine onto waiting list https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Zakaj Self-Referral - Success? •80% o f pa tie nts a c c e ss o ur se rvic e via the we b po rta l •GP ha nds pa tie nt a c a rd •T a ke s pa tie nts a n a ve ra g e o f 15 minute s •T e le pho ny te a m to ta ke info rma tio n if pa tie nts do n’ t ha ve a c c e ss to inte rne t •All re fe rra ls tria g e d within 24 ho urs •3 minute s to T ria g e •E a rly Sig npo sting •E a rly I nte rve ntio n •Sa ve s 0.8 o f a fo llo w up a ppo intme nt •97% F rie nds a nd F a mily Sc o re https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Oprosti Versus https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Združeno kraljestvo The UK •NHS 1948 •F re e a t the po int o f c a re •1977 UKPhysio the ra pists ha ve b e e n a b le to a c t a s 1st c o nta c t pra c titio ne rs •Se lf re fe rra l tria l 2003-2005 •Ove rla st 15 ye a rs the physio ’ s ro le a s c ha ng e d •E vide nc e d b a se d https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
Združeno kraljestvo Scope Of Practice - The UK Physio •Asse ss, dia g no se a nd T re a t •T ria g e pa tie nts •Re q ue st I nve stig a tio ns •Dia g no stic ultra so und ima g ing •Pre sc rib e •I nje c t •Run o utpa tie nt fo llo w up c linic s https://b sc ane sc o nsult.c o m/ b rad@ b sc ane sc o nsult.c o m
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