Patient experience

Data analysis on the role of the Independent Prescriber in Physiotherapy led spasticity clinics

The purpose of this project was to demonstrate the positive impact an Independent Prescriber Physiotherapist could have on the service delivery in outpatient spasticity clinics. The project aimed to demonstrate reduced patient waiting times for review appointments, reduced cost per appointment and demonstrate high patient satisfaction.  The overdue waiting period for spasticity reviews is a long standing problem for the spasticity service and on the Trust risk register. Historically spasticity clinics were managed in multidisciplinary team (MDT) clinics involving a Consultant and a Physiotherapist. A proposal was put forward to the team and agreed. This proposal was for a single Physiotherapist Independent Prescriber, with experience in management of spasticity and neuropathic pain, to set-up a pilot period of Independent Physiotherapy led spasticity review clinics.

Clinical Outcomes Review within a Musculoskeletal (MSK) Risk Stratified Model of Care

Measuring the clinical effectiveness of all healthcare services is a fundamental component of evaluating the impact care has on the service user. A community-based MSK physiotherapy service in Mid Essex has been using a validated and multi-dimensional outcome tool, the Musculoskeletal Health Questionnaire (MSK-HQ), since April 2017 to evaluate clinical effectiveness.

The service also recognised the importance of working in different ways to improve efficiency and matching treatments based on prognostic subgroups (stratified care) has been shown to be both clinically and cost-effective in the management of low back pain using the STarT Back Screening Tool.  However, risk stratified care for all MSK disorders is in its relative infancy, with the Keele STarT MSK Tool yet to be fully validated scientifically, although Keele University granted permission for the MSK physiotherapy service to use the tool for clinical purposes in April 2018. 

The service was therefore able to collect data from all appropriate MSK patients receiving treatment from April 2018 to March 2019 to evaluate whether good clinical outcomes and positive patient experience were demonstrated whilst delivering a more efficient risk-stratified care approach.

A musculoskeletal single point of referral in primary care

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.

Student-Led Neurological Rehabilitation Group

Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to exercise. This study used a mixed methods approach to evaluate participant experiences and outcomes following participation in student-led, community-based neurological groups and to explore the feasibility of performing a full-scale study.

Physiotherapy Supported Discharge Service following knee arthroplasty

An audit on length of stay (LOS) for total knee replacement (TKR) patients following surgery highlighted that a number of patients were exceeding their predicted date of discharge (PDD), many due to not achieving traditional physiotherapy goals (90⁰ flexion, < 5 ° extension lack and good quadriceps function), despite being safely mobile and medically fit. This exposes patients to risk of harm due to prolonged stay within an acute hospital environment as well as inefficient utilisation of an in-patient bed. A Physiotherapy Supported Discharge Service (PSDS) had previously been piloted for six months. Phase 2 consisted of permanent service resign, continuing the PSDS and service evaluation.

Management of Motor Neurone Disease (MND) clients in their own homes

A service for clients with MND was developed over the past 5 years within VCRS to allow this group of service users easy access to the multidisciplinary team (MDT) throughout the duration of their illness.

We are interested in improving the coordination, communication and care of patients with MND, from diagnosis to end of life, supported by NICE (2016) and MNDA guidelines. We developed individual speciality pathways to encourage prudent healthcare and bridged links in service provision to reduce individual therapy visits, duplication of referrals and assessments and ineffective communication within VCRS and the wider MDT.

The purpose of the service evaluation was to examine if the current service provision actually meets the needs of the service users and their families. We also wanted to identify areas which require further improvement.

We are keen to share this piece of work to demonstrate how existing practices can be altered in order to provide a more prudent and equitable service to this group of clients.

Patients with fibromyalgia attending primary care based education seminars and workshops

To ascertain patient feedback following their attendance at education seminars “Understanding Fibromyalgia”, “The role of medications in the management of Fibromyalgia” and a 'Moving forwards workshop' for people with a diagnosis of Fibromyalgia Syndrome (FMS). This is a change from usual practice where patients were seen in specialist secondary care by a member of the medical team. Education and exercise are now prioritised as first-line interventions.

Prescribed Only Medications (POMs) issued in a musculoskeletal physiotherapy primary care

Non-medical prescribing was introduced in the United Kingdom (UK) to improve healthcare service efficiency, access to medicines and support service innovation. From 2013, independent prescribing was extended to include physiotherapists. Patients are facing increasingly long waiting times to see their GPs, and delays getting medication to aid their musculoskeletal ailments. This report aims to explore patient satisfaction of this service in a primary care musculoskeletal physiotherapy setting. IPOPS started provision of independent prescribing during physiotherapy sessions by a single physiotherapy practitioner in March 2017.

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

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.

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