GP MSK Pilot
A pilot for direct access to Physiotherapy was initiated in December 2015 after agreeing the needs and specification of the service with Darlington CCG
On Dec 1st 2015 following collaborative work with Darlington CCG to agree funding and service specification, a Physiotherapy Direct Access service was established within two nominated Darlington GP practices: Whinfield and Moorlands surgeries. This allowed GP receptionists to triage patients requesting GP appointments for an MSK complaint to be booked directly to see a Specialist Physiotherapist within the practice within 48 hours and usually on the same day.
Physiotherapists were available within each practice two hours/day to provide this service and they provided an initial triage appointment offering early advice and recommending on-going treatment if this was indicated. The service was initially a pilot and under review, it is now extended up to the end of March 2017. Also, as the pilot has progressed additional practices, Denmark Street and Rockcliffe Court, which were set up with the ability to refer patients for assessments in the same way as the host practices from August 2016.
This service has demonstrated an innovative approach from AHP’s using specialist skills to improve patient outcomes and experience. Patients had a maximum of 48 hours to wait for assessment and the early intervention provided reduced their need for on-going treatment either within Physiotherapy or Orthopaedics. So staff have developed and used skills to provide high quality care and in turn helped with demand on other services. Not to mention that the cost saving from the avoidance of secondary care referral/treatment, more than pays for the service, never mind the saved GP appointments and on-going treatment sessions.
Initiation and implementation
As a result of discussion at a local MSK forum, work was pursued with the local CCG to establish the service, initially as a six-month pilot.
It took around 9 months from the initial proposal to the CCG, to agreement and implementation.
The proposal was fully supported the Foundation Trust and the CCG leads, throughout the process.
The service was initially funded for six months and then it was agreed to be extended. From 1st April 2017 this service will be incorporated in to a wider tender for local MSK services for the next three years.
Each Physiotherapy appointment was in direct replacement of a GP appointment, consisting of 20 minutes. A total of 1147 patients were seen (up to end Sept 2016) and only 19 (2%) of these required onward referral to the GP so that is 1128 more GP appointments available for other patients to access. The physiotherapists were able to refer for imaging and also secondary care, if necessary.
Of the patients seen 849 (74%) were managed with early advice and did not need on-going treatment and were able to self-manage with good early advice. The remainder of the patients were able to self-refer for on-going Physiotherapy at a provider of their choice.
Early in the pilot it was a requirement for patients to re-attend the practice for any prescriptions provided by the GP on the advice of the Physiotherapy assessment. This element of the pathway was further improved as two of the lead Physiotherapists involved completed independent prescribing qualifications so prescriptions can now be offered at the appointment. We do not currently have any data on specific prescription numbers or savings.
One final parameter of success was the level of patients referred from each practice for consultant opinion. The eight-month period January – August 2016 was directly compared with the same period in 2015 and it is noted that 209 or 18% fewer referrals were made.
70 patients filled out a satisfaction survey across both locations;
- 94% rated the length of appointment as 8 and above
- 96% rated the assessment and advice given as 8 and above
- 93% rated the outcome of the visit as 8 and above
- 100% said that they would use the service again for joint/muscle pain complaints
- 100% said that they would recommend the service to family and friends
Patients comments included;
‘Preferred this service’
‘Excellent idea to have a Physio in the practice’
‘Superb advice including referral’
‘A very efficient “triage” system, as the Physio has been able to point me in the direction of (hopefully) effective treatment’
‘Physio was very knowledgeable and helpful. His examination of the area was excellent and we are very happy with the advice and exercises received’
‘Brilliant service with expert advice and seen so quickly. Feel completely reassured about my back problem and have exercise plan. Thanks so much!’
‘Excellent to be seen straightaway’
‘The lady who we saw was brilliant and very helpful. A big pat on the back to her. Thank you.’
‘This service is brilliant, saves a lot of time, worry and stress’
‘Very happy with skill & knowledge of the Physio. Thank you’
‘The experience today felt successful. I feel like I am leaving with some useful advice rather than the usual painkillers.’
Cost and savings
Costs included 20 hours of Band 7 Physiotherapy time and 10 miles of standard NHS travel expenses per week.
Based purely on saved initial secondary care consultant appointments, savings were in excess of £26K over 7 months.
1128 GP appointments were saved and a subsequent reduction in follow up appointments.
What did you learn?
The pilot was successful in achieving outcomes which were
- To see patients referred within 48hrs
- To reduce burden on GP’s by managing the patients referred
- Reduce secondary care referrals
We learnt how to establish and provide a successful model of direct access but could have improved further on appointment utilisation, but we have positively changed service delivery as a result of this pilot.
That physio works! (But we already knew that!)