18 Week RTT

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18 Week RTT MSK Event

• Judith Park, General Manager for Surgical and
  Critical Care

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Programme for the Day
Time Item Lead Session Outline
10.00 10.15 Welcome Overview of the Programme for the Day Judith Park, General Manager for Surgery and Critical Care
10.15 10.45 Introduction of Patient Advice Line Ruth Currie, Senior Physiotherapy
10.45 11.45 Development of MSK Model J Thompson, Consultant Physiotherapist MSK Services
11.45 12.00 Questions
12.00 12.45 Lunch Networking 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
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SELF REFERRAL TO PHYSIOTHERAPY

• RUTH CURRIE
• PHYSIOTHERAPY TEAM LEAD

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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

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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

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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)

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THE ROLL OUT

• JANUARY 2010
• PHYSIOTHERAPY ASSESSENT LINE
• (PAL)

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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

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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

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THE SYSTEM

• Telephone system
• Computer database
• Experienced clinicians

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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

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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

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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

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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!

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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

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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

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CALL OUTCOME

• Self Manage and Discharge
• Routine Appointment
• Urgent Appointment
• Emergency Referral to AE
• Information only
• Advised GP visit
• Salus Health for Employability
• Salus Working Health Services

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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

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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

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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 AE and
  speaks to the receiving registrar.

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Information Only

• Enquiries regarding uplift or return of
  equipment, appointment times, referral processes,
  etc

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Advised GP visit

• To discuss medication / pain control
• For a written referral if communication not
  possible via the telephone
• For outcome of investigations

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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

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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.

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2010 Data

• Incoming calls 31,488
• Calls answered 12,230
• Completed Assessments 11,688
• Referrals to Physiotherapy - 8621

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2011 Data to end September

• Incoming calls 31,947
• Calls answered 13,751
• Completed assessments 12,814
• Referrals to Physiotherapy - 9151

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DATA FOR PERIOD JANUARY 2010 TO JULY 2011
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The Benefits of Self Referral to
PhysiotherapyPAL
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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

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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

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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

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The Challenges

• Answering all our incoming calls
• Coping with computer crashes
• Staff absence / holidays
• Balancing time on telephone assessment with 11
  patient assessment and treatment

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The Future

• NHS 24
• Janie Thomson