Patient satisfaction and outcomes of MSK pain patients accessing Advanced Physiotherapy Practitioner in primary care

Purpose

The service objectives are to:

  1. Reduce workload of GPs
  2. Provide assessment and self-management
  3. Provide high quality care and a good patient experience to patients with MSK problems
  4. Support patients to remain in/return to work
  5. Provide staff with a positive experience.

The purpose of this project was to evaluate and monitor the progress and growth of the service against our service objectives

Some of the driving forces behind the Advanced Physiotherapy Practitioner (APP) are the 5 Year Forward View, GP Forward View, local Sustainability and Transformation Partnerships and local GP Cluster priorities. These drivers focused on workforce transformation within primary care and the MSK pathway. This service will enable patients to access a specialist MSK services at the beginning of the pathway.

This project also aimed to examine the outcomes of APP appointments to determine referring habits, changes in referral patterns and effects on GP workload and secondary care referrals.

Approach

This service evaluation took place over one month in 2018 in five GP practices which make up the St Pauls Medical Centre Cluster in Gloucestershire. The APP service sees patients with MSK complaints aged 18 and over. At the time of the evaluation there were 3 APPs covering a 4 day a week clinical service.

There were two aspects to this service evaluation; a patient satisfaction survey and a clinical data collection element.

This patient satisfaction survey collected patient opinions and comments about the service, its accessibility, and timing of appointments as well as overall patients satisfaction. This survey was given to patients after attending their appointment which was completed immediately after their appointment and handed into reception. The clinical data was collected by the APPs after each consultation using a simple excel spreadsheet tally system.

Outcomes

Findings from the patient survey include positive patient comments, specifically in regards to access of appointments. Patients commented on the benefit of being able to book an appointment on the same day.

Findings from the tally chart data collection include data from 91 patients seen within a month period demonstrate:

  • 100% of patients received self-management advice
  • 94% of patients received exercise prescription
  • 23% of patients received advice about how to use their pain medication effectively and safely.
  • 16% of patients were referred on for a course of physiotherapy.
  • 13% of patients were referred back to GP for bloods, medication requests, requests for sick notes or as inappropriate.
  • 9% of patients were referred to secondary care orthopaedics or into interface services.
  • 3% of patients were referred for further imaging.

Cost and savings

The service evaluation was set up and organised within the current clinical timetable and budget. No additional costs were required for the service evaluation.

Implications

Patients were positive about the service, specifically about speed and access to appointments. The number of completed patient surveys returned was less than expected. This is a weakness of the evaluation therefore the next step may be to follow up patients after their appointment with a reminder to complete the survey or to provide the survey electronically. The depth of data collected was limited by the range of questions asked and multiple choice responses therefore another approach may be to conduct qualitative work to  gather richer patient feedback.

Findings from the tally chart data suggest that concerns regarding increasing onward referral to physiotherapy, secondary care or back to GPs were unfounded. The most common outcome from an APP appointment was self-management, advice and exercise prescription.

Learning from this evaluation could be useful as APP roles in primary care are taken on nationally and locally. These findings demonstrate the ability of an APP model to provide an accessible and timely access to MSK expertise. These findings could also be used to allay concerns for other practices looking into this model of workforce.

Since this first service evaluation of the APP service was completed our team have expanded this work. For example we have collected longer term data on patient outcomes after a single APP appointment, we have also continued with the excel spreadsheet tally information to collect data on referral source, appointment use, condition, outcome, onward referral and utilisation of advanced skills. We have also been involved in the qualitative study conducted by the University of Nottingham in which patients and staff were interviewed about their views of the service. We have conducted a wider ranging patient satisfaction survey over a 6 month period in partnership with the local public health team and we continue to contribute to the national data collection template and Phase 3 national FCP evaluation.

We have used the knowledge gleaned from this project and other data collection projects to adjust our appointment system, provide education about our service to primary care staff and key stakeholders and to adapt our service provision for patients.

Top three learning points

  1. Patients appreciated on the day appointments and this often exceeded their expectations.
  2. Patients did not know what the role of an APP was and didn’t therefore know what to expect from their appointment.
  3. APP services refer less than 10% of patients to secondary care, less than 15% back to the GP and less than 20% to physiotherapy services.
  4. APPs refer only 3% of patients for imaging
  5. APPs offer self-management advice to 100%, exercise to 94% and advice about effective medication usage to 23% of patients
  6. This data suggests that commonly expressed fears about increased referrals after the implementation of APP services may be unfounded.

Fund acknowledgements

This 12 month pilot role is funded by the Gloucestershire Clinical Commissioning Group. No additional funding was given for the evaluation.

Additional notes

This work was presented at Physiotherapy UK 2018