Advanced Practitioner Physiotherapist as First Point of Contact in Lanarkshire

Purpose

  • to shift capacity from GP to APP
  • to demonstrate APPs are a safe, effective and efficient resource
  • to measure outcomes of each consultation
  • to evaluate patient and practice satisfaction
  • to evaluate the effect on referral to acute specialities
  • to pilot the use of vision 360

Approach

1.2wte Advanced Practice Physiotherapists were appointed to a group of 3 GP practices within East Kilbride with a total practice population of approximately 14000. A script was developed collaboratively to enable effective screening and booking of MSK patients to the APP.

Twenty minute consultations allowed for specialist assessment, MSK diagnosis and management, plus screening for non MSK conditions. Consultation outcomes and patient experience were captured from each consultation and the data presented at 6 week, 3 month and 6 month to understand and evaluate the impact of the role .Vision 360 was implemented in January 2018 to enable electronic appointing and recording.

Outcomes

6 month data: Appointments booked to date: 878

Outcomes:

  • self-management and discharge 60.8%
  • routine referral to physiotherapy 12.8%
  • urgent referral to physiotherapy 4.2%
  • referrals to other services 2%
  • referrals for x-ray 2.3%
  • GP for medication 3.4%
  • Injection from APP 1.4%
  • Cancelled/failed to attend 11.5%

Patient experience questionnaire - all positive feedback

  • ‘quick and smooth process’
  • `delighted to have appointment so quickly’
  • `offered really useful advice and reassurance`.

Implications

The early data demonstrates the effectiveness of the role of the APP within Primary Care and supports the pilot aims/objectives.

The majority of a GP`s MSK caseload can be seen safely and effectively by a physiotherapist without a GP referral, in agreement with the newly agreed GMS contract which states `The Expert Medical Generalist will be supported by a multidisciplinary team delivering improved levels of care in the community’.

Fund acknowledgements

Primary Care Transformation Fund

Additional notes

This work was presented at Physiotherapy UK 2018.