18 Week RTT – MSK Event

Judith Park, General Manager for Surgical and Critical Care

Programme for the DayTime 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

12.45 - 13.45 Moving ForwardE clinic, national pilot

J Thompson, Consultant Physiotherapist MSK Services

13.45 – 14.00 Close Judith Park, General Manager for Surgery and Critical Care

SELF REFERRAL TO PHYSIOTHERAPY

RUTH CURRIEPHYSIOTHERAPY 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 – 31,488Calls answered – 12,230Completed Assessments –

11,688Referrals to Physiotherapy - 8621

2011 Data to end September

Incoming calls – 31,947Calls answered – 13,751Completed assessments –

12,814Referrals to Physiotherapy - 9151

INCOMING CALLS

0

200

400

600

800

1000

1200

1400

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

INCOMING CALLS V CALLS ANSWERED

0

200

400

600

800

1000

1200

1400

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

TRUE9%

SUGGESTED91%

GENDER

MALE40%

FEMALE60%

AGE RANGES

975

572

753

1145

1597

706

393

0

200

400

600

800

1000

1200

1400

1600

1800

<16 16-20 21-30 31-40 41-50 51-64 65-74 >75

EMPLOYED V NOT EMPLOYED Jan 10 - July 11

12307, 48%

5063, 19%

8643, 33%

EMPLOYED NOT IN EMPLOYMENT UNDER 65 NOT IN EMPLOYMENT OVER 65

CALL OUTCOMES

APPOINTMENT ROUTINE60%APPOINTMENT URGENT

16%

SELF MANAGE AND DISCHARGED22%

ADVISED GP VISIT2% EMERGENCY REFERRAL

0%

PATIENT CONDITION

1378

683

1303

621

795

196

116

8 00

200

400

600

800

1000

1200

1400

1600

ALBP NECK UPPER LIMB KNEE LOWER LIMB MULTI OTHER NEURO UROLOGY

NU

MB

ER

OF

RE

FER

RA

LS

REFERRALS TO CLINICS

175

109 110

311

506

71

227

36

133

4927

179

106

23

106

203

33

104

152

307

214

133

257

131

552

0

100

200

300

400

500

600

NU

MBE

R O

F R

EFER

RA

LS

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