North West

Population health and prevention is a major priority of the recently formed Greater Manchester Health and Social Care Partnership and is an area in which physiotherapists can make a positive contribution. The Physiotherapy MSK services within the Bury Care Organisation, have successfully developed a MECC model of practice into their service pathways. This quality improvement, uses evidence based behaviour change principles to support patients in making positive lifestyle changes which can impact on their physical and mental health and wellbeing. It also aims to support Trust staff to become more active and promotes health and wellbeing within the wider communities.

Following the building of a local state of the art hydrotherapy facility a local umbrella charity Bolton Neuro Voices approached SP Therapy Services to design and deliver a 5 week hydrotherapy programme to persons living with a neurological conditions in Bolton and the surrounding area.

The brief was to be safe, inclusive and effective and to be within a specific budgetary and time constraints of a specified charity bursary. In addition we needed to provide sufficient evidence to enable future applications for bursary funding.

Prehabilitation has been shown in clinical trials to improve fitness, improve quality of life, reduce complications, reduce hospital length of stay and improve recovery. It is not currently standard of care in routine clinical practice. This prospective observational study reports the outcomes of a newly introduced prehabilitation service for patients undergoing major abdominal surgery for cancer.

To describe the transformation process undertaken over two and half years and share our experience of the redesign in both terms of success and challenges.

In May 2016 rheumatology referrals were outstripping service capacity, leading to increasing waiting times for new patients. Following a review of new patient referrals the team identified that a significant proportion of referrals, though being appropriately referred to rheumatology, were for non-inflammatory conditions. Recognising the changing landscape of the NHS and the emphasis to look at different ways of working we put forward a proposal to pilot a rheumatology advanced practitioner physiotherapist (APP) with the following aims: -

• Improve the triage process
• Streamline the pathway for new patients with non-inflammatory conditions
• Reduce waiting times

The incidence of cancer is increasing; people are living longer with better quality of life, however, the risk of developing MSCC remains high for many patients. Prompt diagnosis and treatment is essential to prevent paralysis and failure to recognise the early signs can have devastating implications with the added financial burden of caring for bedbound patients.

All front-line clinicians have a vital role to play in referring suspected MSCC patients into the MSCC service in a timely manner. This includes physiotherapists working in most settings, e.g. MSK, A&E, walk-in centres, community and private sector.

Historically patients at North Manchester General Hospital received traditional 1:1 Physiotherapy treatments post total knee replacement (TKR). Literature suggests a class environment can be more cost effective and yield improved results. Therefore a TKR class was set up in 2015. This summary highlights the findings from the first year demonstrating clinical outcomes, patient satisfaction and cost-effectiveness.

To evaluate the implementation of a service redesign for patients with suspected scaphoid fractures. A scaphoid fracture is a diagnostic and radiographic challenge for clinicians with heterogeneity of assessment and treatment nationally. We propose an advanced physiotherapy led model that reduces both direct and indirect costs to the patient, trust and NHS that is shown to be safe and effective.

Metastatic spinal cord compression (MSCC) is a well-recognised complication of cancer. The National Institute of Clinical Excellence (NICE) provided clinical guidelines regarding assessment and management of patients with back pain and cancer history with suspected spinal cord compression; NICE CG-75. This study aims to determine if patients are managed appropriately and in a timely manner, according to these guidelines.

'Advancing Quality' (AQ) was launched in 2008 across all hospitals in the north west of England with the aim of improving patient outcomes and reducing costs (Advancing Quality Alliance 2016). In 2015 the management of hip fracture was added as a key clinical area for evaluation/improvement, and included the measure: 'HFR-07 - Physiotherapy assessment within 24 hours of surgery'. Our Trust audit department therefore started producing monthly data for AQ hip fracture targets, which initially revealed our compliance with the above physiotherapy measure to be at 78% (target set at 100%). The purpose of this project was therefore to improve the achievement of this measure. A Plan-Do-Study-Act (PDSA) service improvement approach was chosen - as initially described by Deming (1986), and then later adapted specifically for use in healthcare by Langley et. al. (1996).