st
1
Line
Physiotherapy
AHP Summit 2014
Rob Goodwin, Clinical Lead
Physiotherapist, MSK Clinics Team
Introduction
The drivers
Historical
Political
Local
Evidential
The
proposal
The
implementation
The Political Drivers
 Simon Stevens
 Chief Executive of the NHS
 Service pressures are intensifying, and longstanding problems
are not going to disappear overnight. As my predecessor
David Nicholson has pointed out, this year is going to be a
challenge and 2015/16 even more so. No one person can fix
everything that needs fixing – certainly not me. Successfully
navigating the next few years is going to take a team effort –
involving the biggest team in the biggest effort the NHS has
ever seen. (April 2014)
The Political Drivers
Improving general practice- A Call to Action (April 2014)
 an ageing population, growing co-morbidities and increasing patient
expectations, resulting in large increase in consultations, especially for
older patients, e.g. 95% growth in consultation rate for people aged 85-89 in
ten years up to 2008/09. The number of people with multiple long term
conditions set to grow from 1.9 to 2.9 million from 2008 to 2018;
 increasing pressure on NHS financial resources, which will intensify further
from 2015/16;
 growing dissatisfaction with access to services. The most recent GP Patient
Survey shows further reductions in satisfaction with access, both for inhours and out-of-hours services. 76% of patients rate overall experience of
making an appointment as good;
 persistent inequalities in access and quality of primary care, including
twofold variation in GPs and nurses per head of population between more
and less deprived areas;
 growing reports of workforce pressures including recruitment and
retention problems.
The Political Drivers




Improving General Practice- A Call to Action (2014)
Phase 1 report
Better partnerships:
a more innovative approach to planning and delivering
services by way of shared learning and ideas
 Empowering clinicians:
 ensuring high-quality support for innovation and
improvement, developing networks to allow more rapid
spread of innovation, supporting general practice in
developing new models of provision, and releasing time
for patient care and service improvement.
The Political Drivers
 Previous papers:
 Healthy Life's, Healthy People; Our Strategy for Public
Health in England (2010)
 Unleashing innovation and liberating professional
leadership
 Empowering local leadership and encourage wider
responsibility to improve everyone's health and wellbeing
The Political Drivers
 Previous papers
 Equality and Excellence; Liberating the NHS (2010)
 Moving commissioning to GP’s will mean redesign and
patient pathways is always clinically-led
 Autonomy for providers
 Create the largest and most vibrant social enterprise
sector in the world
Advanced roles
 ‘clinical specialists with an extended
scope of practice i.e. working beyond
the recognised scope of practice of the
profession of interest in innovative or
non-traditional roles’.
Advanced roles
 Drivers associated with ‘modernisation’
 Service redesign, staff and skill shortages, new health
care technologies, improvements in quality, cost
containment
 Professional aspirations
 Increased job satisfaction, autonomy in practice, role
and career development
Advanced roles
 Nursing
 AHP’s
 Meeting the Challenge- A Strategy for
the Allied Health Professions (2000)
Advanced roles
However, the role of the allied health professions has too often been
undervalued or neglected. The Government is committed to changing
this. The NHS Plan already sets out clear commitments to these staff,
in particular that there will be, by 2004,
 over 6,500 more therapists and other health professionals,
 4,450 more therapists and other key professional staff being trained
and
 new therapist consultant posts
And we are committed to expanding the roles which the allied health
professions play in health and social care, ensuring they can use their
skills flexibly and creatively to the benefit of patients.
Evidence for advanced roles
 AHP’s
 McPherson, K, Kersten, P et al, 2006
 A systematic review of evidence about extended roles
for allied health professionals
Physiotherapy advanced roles
 McClellan CM et al, 2006
 Effect of an extended scope physiotherapy service on
patient satisfaction and the outcome of soft tissue
injuries in a adult emergency department
 Pearse EO et al, 2006
 The extended scope physiotherapist in orthopaedic
out-patients- an audit
Physiotherapy advanced roles
Patient and staff perceptions
 Reeve S and May s, 2009
 Exploration of patient’s perspectives of quality within an
extended scope physiotherapy spinal screening service
 Kennedy DM et al, 2010
 Patients are satisfied with advanced practice
physiotherapists in a role traditionally performed by
orthopaedic surgeons
 Bath B and Janzen B, 2011
 Patient and referring health care provider satisfaction with
a physiotherapy spinal triage assessment service
Physiotherapy advanced roles
Systematic reviews
 Stanthorpe J et al, 2012
 Extended scope physiotherapy roles for orthopaedic
outpatients: an update systematic review of the
literature
 Desmeules F et al, 2012
 Advanced practice physiotherapy in patients with MSK
disorders: a systematic review
A local coming together
Perceived local
pressures
Local MSK
Physiotherapy
developments
Clinical
Leadership
Local
relationships
Innovative
practice
GP burden
The Proposal
Leverage!
Main cohort >400
patients
56 physiotherapy
patients
54 GP patients
Physiotherapy group
had greater selfefficacy
Close co-operation
meant no extra
appointment for xrays, blood tests etc
6% referred to GP due
to suspected ‘red
flags’
9% returned to see
their GP with the same
problem
More patients had
‘complete confidence’
in physiotherapist than
GP
Significant differences
in patient satisfaction
Physiotherapy group
had better information
about disorder and
self care
Realising the proposal
1st Line Physiotherapy
 2 GP practices
 2 half days clinics
 Pre-launch training
 Outcome measures
 Evaluation
20 minute
appointments
Maximum capacity of
9 new patients per
clinic
EQ 5D
CARE Scale
Patient satisfaction
1 month
6 months
1 year
Qualitative evaluation
1st Line Physiotherapy