18 Week RTT – MSK Event
Judith Park, General Manager for
Surgical and Critical Care
Programme for the Day
Time
Item
Lead & Session Outline
10.00 – 10.15
Welcome & Overview of the
Programme for the Day
10.15 – 10.45
Introduction of Patient Advice Ruth Currie, Senior Physiotherapy
Line
10.45 – 11.45
Development of MSK Model
11.45 – 12.00
Questions
12.00 – 12.45
Lunch & Networking
12.45 - 13.45
Moving Forward
E clinic, national pilot
J Thompson, Consultant
Physiotherapist MSK Services
13.45 – 14.00
Close
Judith Park, General Manager for
Surgery and Critical Care
Judith Park, General Manager for
Surgery and Critical Care
J Thompson, Consultant
Physiotherapist MSK Services
SELF REFERRAL TO
PHYSIOTHERAPY
RUTH CURRIE
PHYSIOTHERAPY TEAM LEAD
BACKGROUND
• 2007/8 – Physiotherapy waiting lists across
NHS Lanarkshire inequitable. Varying from
3-4 weeks in some sites to 36 weeks in
others
• NHS L had never introduced self referral to
Physiotherapy in any format
AIMS
• To create equity in waiting times across
NHS L
• To reduce waiting times for physiotherapy
across NHS L
• To increase access to Physiotherapy
• To offer advice and enable some to self
manage their condition
THE PILOT PHASE
• An 18 month preparatory phase in 2008/9
to reduce waiting times and waiting lists
• Temporary staff employed for 18 months
• A 6 month trial of the a telephone self
referral service to Physiotherapy in 2
locations – Clydesdale (rural) and
Motherwell (urban)
THE ROLL OUT
JANUARY 2010
PHYSIOTHERAPY ASSESSENT
LINE
(PAL)
Monday to Friday
9am – 12 noon
Open to all adults who live in Lanarkshire
who have a musculo-skeletal problem for
which Physiotherapy advice or intervention
may be of benefit
Patients must be :
• Able to communicate via the telephone
• Present to give their consent
• Be available for assessment within office hours
• If not, a GP referral may be more appropriate
THE SYSTEM
• Telephone system
• Computer database
• Experienced clinicians
TELEPHONE SYSTEM
•
A single telephone number for every Lanarkshire resident to use
•
01236 713901
•
Through an English based Telephonetics system
•
No queuing
•
A voice mail option
•
Up to 30 incoming telephone lines
COMPUTER BASED SYSTEM
• An electronic physiotherapy assessment
• Linked in with CHI so demographics can be pulled
down for Lanarkshire residents
• A clinical based assessment tool
• The telephone assessment takes on average 10 –
15 minutes
EXPERIENCED CLINICIANS
• All band 6 and 7 MSK physiotherapists
• Some band 5 Physiotherapists who had at least 2
years MSK experience with sound clinical
reasoning skills and well developed
communication skills
• Over 60 physiotherapists currently involved
TRAINING PROGRAMME
– 1.5 hour teaching session with PAL manual
and introduction to the IT system
– A 1.5 hour mock call session
– A 1.5 hour supervised call back session
Then Go Live!
VOICE MAIL
• Computer based secure call back site for all
voicemails
• SLA is to call back those who leave a message
within 2 working days
• X2 attempts made to reach the patient
• Voice message left
A TYPICAL DAY
• 9am – 12 noon : up to x10 physiotherapists ‘live’
• Each physiotherapist can take between 10 and 15
calls
• 1.30pm – 4.30pm : up to 3 physiotherapists on
‘call backs’
CALL OUTCOME
•
•
•
•
•
•
•
•
Self Manage and Discharge
Routine Appointment
Urgent Appointment
Emergency Referral to A&E
Information only
Advised GP visit
Salus – Health for Employability
Salus – Working Health Services
Self Manage and Discharge
Option to
- Send some simple evidence based exercises for
specific joints/ conditions
- Direct to evidence based web pages
- Information can be sent via email (non reply email
address for PAL)
- Ask to call back within a specific time period if no
or limited improvement
Appointed patients
• Referral sent electronically to our 26 MSK
sites and downloaded daily
• Each department follows the same MSK
prioritisation criteria
• Routine – within 9 weeks
• Urgent – within 5 working days
Emergency Referral
• Any patient who, through the clincial reasoning
process, is identified to be suffering from a
condition which may require immediate medical
attention
(eg: cauda equina)
Physiotherapist phones ahead to A&E and
speaks to the receiving registrar.
Information Only
• Enquiries regarding uplift or return of
equipment, appointment times, referral
processes, etc
Advised GP visit
• To discuss medication / pain control
• For a written referral if communication not
possible via the telephone
• For outcome of investigations
Salus – Health For Employability
• For those who are unemployed and who
have a health condition which may be
preventing them from accessing
employment or training
• A case management approach
Salus – Working Health Services
• Private Physiotherapy provided for those
who are self employed or who work for a
small business of less than 250 employees.
2010 Data
Incoming calls – 31,488
Calls answered – 12,230
Completed Assessments – 11,688
Referrals to Physiotherapy - 8621
2011 Data to end September
Incoming calls – 31,947
Calls answered – 13,751
Completed assessments – 12,814
Referrals to Physiotherapy - 9151
I N C OM I N G C A LLS
1400
1200
1000
800
600
400
200
0
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89
I N C OM I N G C A LLS V C A LLS A N S WER ED
1400
1200
1000
800
600
400
200
0
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93
DATA FOR PERIOD
JANUARY 2010 TO
JULY 2011
REFERRAL TYPE
TRUE
9%
SUGGESTED
91%
GENDER
MALE
40%
FEMALE
60%
AGE RANGES
1800
1597
1600
1400
1145
1200
1000
753
800
706
572
600
393
400
200
75
9
0
<16
16-20
21-30
31-40
41-50
51-64
65-74
>75
EMPLOYED V NOT EMPLOYED Jan 10 - July 11
8643, 33%
12307, 48%
5063, 19%
EMPLOYED
NOT IN EMPLOYMENT UNDER 65
NOT IN EMPLOYMENT OVER 65
CALL OUTCOMES
ADVISED GP VISIT
2%
EMERGENCY REFERRAL
0%
SELF MANAGE AND DISCHARGED
22%
APPOINTMENT URGENT
16%
APPOINTMENT ROUTINE
60%
PATIENT CONDITION
1600
1400
1378
1303
NUMBER OF REFERRALS
1200
1000
795
800
683
621
600
400
196
200
116
8
0
NEURO
UROLOGY
0
ALBP
NECK
UPPER LIMB
KNEE
LOWER LIMB
MULTI
OTHER
BE
LL
SH
ILL
VI
EW
PA
NE
RK
W
AR
TH
CO
ILL
AT
BR
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GE
CE
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OR
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RV
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W
SH
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TS
CL
EL
EA
ND
LA
NA
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BI
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LA
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HO
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UK
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HU
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RE
LA
S
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RE
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AL
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ON
IR
MY
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MO
S
NK
W
IS
L
AN
HA
DS
W
GE
RU
NE
TH
RA
ER
L
GL
EN
PC
C
NUMBER OF REFERRALS
REFERRALS TO CLINICS
600
200
100
552
506
500
400
311
109
307
300
227
257
175
179
203
133
71
36
152
110
106
27
106
49
23
33
133
21
131
104
4
0
The Benefits of Self Referral to
Physiotherapy
PAL
Benefits to the Patient
• Immediate access to Physiotherapy advice
• Experienced clinician with sound clinical
reasoning skills
• Access to electronic or paper based advice
and exercise
• An alternative method of referral
Benefits to the GP
- PAL business cards available in all GP
practices
- Less time consuming than writing or
dictating a written referral
- Cost effective
- Places the onus on the patient to initiate
the referral
Benefits to Physiotherapy Service
• More accurate information on the referral
• Patient usually already commenced some
home exercise or advice
• A percentage self manage
• Reduced inappropriate referrals
• Reduced NP : Return patient ratio
• Equitable waiting lists and times
The Challenges
•
•
•
•
Answering all our incoming calls
Coping with computer crashes
Staff absence / holidays
Balancing time on telephone assessment
with 1:1 patient assessment and treatment
The Future
• NHS 24
• Janie Thomson