A musculoskeletal single point of referral in primary care

Purpose

A single point of referral was implemented in partnership between Allied Health Professionals Suffolk (AHPS) and Norfolk Community Health and Care (NCHC) forming the Integrated Therapy Partnership (ITP). This aimed to standardise the care pathways for musculoskeletal conditions and ensure primary care referrals are processed to the correct provider first time around. This should avoid unnecessary secondary care referrals, where patients are seen in secondary care, receive no treatment and are referred back to community providers. Referrals are triaged by senior physiotherapists. Similar models have been suggested as effective methods of service delivery by the British Orthopaedic Association (Lennox & Karstad, 2013). This was coupled with the implementation of online self-referral for physiotherapy and occupational therapy, where patients were issued advice and exercise within 24 hours. Advice and exercise are issued for patients triaged for physiotherapy through the single point of referral. AHPs are responsible all patient administrative tasks and provide the triaging clinicians. NCHC provide clinical physiotherapy, occupational therapy and orthopaedic triage services. This is contracted to the Norwich and South Norfolk Clinical Commissioning Group and they set key performance indicators for patients being seen. Routine patients to be seen in 28 working days, urgent patients to be seen in 7 days and orthopaedic triage patients to be seen in 14 working days.

95% of patients
seen within the target waiting time

Approach

Data on appointment waiting times was recorded for internal and commissioners reporting. This is compared to the KPI and the percentage achieved is analysed. This has been done across the timeframe following implementation.

Orthopaedic conversion to surgery rates were supplied by the local regional hospital. Patient satisfaction rates were collected following discharge from the service.

Outcomes

In the initial 17 months of the service running the revised model the percentage of patients being seen within the KPI's for waiting times has increased for routine, urgent and orthopaedic triage appointments. Within the last 3 months of reported data each service has achieved their target of 95% of patients seen within the target waiting time.

The current (March 2018) patient service satisfaction rate is 85%. The current (March 2018) orthopaedic conversion rate to surgical intervention is 70%, compared with a national average of 55% with a traditional direct referral pathway.

Implications

A single point of referral combined with online self-referral for musculoskeletal complaints is effective at shortening the waiting times for physiotherapy, occupational therapy and orthopaedic triage patients. This service also impacts on the surgical conversion rate for orthopaedics receiving referrals via this pathway. Patient satisfaction remains high.

This service redesign model could be transferred to other primary care settings where there are long waits for musculoskeletal or where there is a high incidence of inappropriate referrals to secondary care is delaying patient care.

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy UK 2018.