1 / 26

PHYSIO DIRECT

PHYSIO DIRECT. JILL GAMLIN - CONSULTANT PHYSIOTHERAPIST KATHY DUFFIELD - SENIOR I PHYSIOTHERAPIST. Catalysts for change………. Personal Dissatisfaction. Patient Dissatisfaction. Time to Think. Right Time....Right Place. Patient dissatisfaction.

tucker
Download Presentation

PHYSIO DIRECT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. PHYSIO DIRECT • JILL GAMLIN - CONSULTANT PHYSIOTHERAPIST • KATHY DUFFIELD - SENIOR I PHYSIOTHERAPIST

  2. Catalysts for change……….. Personal Dissatisfaction Patient Dissatisfaction Time to Think Right Time....Right Place

  3. Patient dissatisfaction • Delayed referral, patients’ problems become more chronic, more difficult to resolve, poorer outcome of treatment • Research evidence - early intervention, aids patient recovery • Current patient pathway through the system had bottlenecks and wasted patients’ time • Frustration for all those involved

  4. Previous Patient Pathway Patient Hospital Consultant GP Discharge NSAID and or Analgesia Not Resolved Physiotherapy 2/52-6/52 to triage Not Resolved Physiotherapy extended scope practitioner Consultant Physiotherapist

  5. Time to think • Stuck in a traffic jam, chance comment Radio 4 - GPs used as inappropriate gate keepers for the NHS • Why not let patients access physiotherapy directly if they think we can help them? • Requires a new approach to assessment and management. • NHS Direct why not Physio Direct?

  6. Right environment • Line manager excited and receptive to new ideas • Dissatisfaction with the present, willingness to change • PCT management ready to facilitate and support the change process financially and with key personnel

  7. Key Objectives • Improve access and capacity for physiotherapy to ensure early identification and management of problems • Empowerment of individuals to take control thus reducing chronic pain • Pathway redesign reducing GP time dealing with M/S problems, ensuring appropriate referral to secondary care

  8. Process of project development • Early involvement of key players - PT team, head of primary care, IT, GPs, practice managers, patients, pharmacy, PEC • Clear vision - good communication, focus on improving patient-centred care • Open approach to problem solving, can do philosophy, negotiation • Attention to risk management, clinical governance

  9. Project development • Reflective learning to capture problems and solutions and to carry learning forward • Strong leadership to find solutions rather than allowing derailment. Conviction, determination, confidence that the direction is right • Seeking advice from wherever is necessary to resolve the next problem

  10. Project details • 2 GP practices involved representing 23,000 patients • 1 practice enthusiastic and innovative, the other had longstanding problems with access • Initially a 6 month project which started Nov 01 with £15,000 funding for 1 WTE senior I PT

  11. How it works • Dedicated phone line open 8.30am-12.30pm Mondays to Fridays excluding BH • Computerised screening tool – patient details, different screens for problems such as LBP, neck, thoracic spine, peripheral joints • Decision made re diagnosis, advice sheets sent by post that day

  12. How it works • If unable to make a sound clinical decision or problems with patient comprehension – appointment to be seen by PT • Inappropriate for PT – d/w Consultant PT re further investigations/management including ref onto other Consultants, suspected fracture – ref A&E • Same day information to GP re consultation, advice sent to patient with clear instructions to call PT Direct back if not resolving

  13. How it works • Training by Pharmacy to PT to ensure safe advice re OTC medication • Prescription – faxed request to GP for prescription for patient to collect if in agreement • Agreement for PT to request sick certificate for 2 weeks without GP appointment

  14. Referral Pathways Patient Physio Direct GP Orthopaedic Consultant Rheumatology Consultant Extended Scope Practitioner Consultant Physiotherapist

  15. Key aspects - ‘outside the box’ • Different ethos - locus of control passes to patient • First contact by phone, computerised screening tool. Advice sent by post same day • Local agreement sick certificates and prescriptions • Consultant Physiotherapist led service from primary to secondary care

  16. Outcome of new service • 70% of callers managed with telephone advice only • Easier access • DNA rate for appointments reduced 15% - < 1% • Reduced GP appointments for M/S patients • Faster access to secondary care consultants when required.

  17. Audit • 100 patients selected randomly, 63 returned • Of the 63, 36 received advice + exercise sheets only, 27 advice + at least 1 appointment • Figures given are for both groups added together • 31 rated service as excellent, 20 good, 9 average, 1 below average, 1 poor, 1 no comment • Positive comments made by both groups regarding access, time saved and quality of the service

  18. Patient comments • “The prompt and direct service received can be followed with confidence in the knowledge it comes from those best qualified to give it . This much needed and valued service should continue” • Some more negative comments, difficulty understanding exercises from the sheet, opening times not convenient, time taken to go through questions, already doing exercises so no help

  19. Outcome • 15 resolved completely • 33 improved but not resolved • 7 not helped • 14 of the not resolved group contacted PT direct again • Some still receiving treatment • 6 went back to the GP

  20. Future use of the service • 56 would use the service again, 4 would not • 57 would recommend the service to others, 4 might, 2 would not – these were in the advice only group • 1 letter of complaint related to the title of the exercise sheet, resolved with one appointment

  21. GP audit results • Overall happy, one surgery felt consultations were quicker, patients don’t come back to chase PT appointment • Helps patients to be proactive • Improved communications PT and GP • Improved access for Orthopaedic opinion • Allows patients to decide whether they will pursue PT • Helps prevent chronicity

  22. PT audit results • All 5 PTs commented on the speed of access, more patient control, patients don’t have to pay for the car park or leave work • Problems – communication with GPs, patients returning to GP rather than staying with the service • Access to consultant PT • Stressful coping with the additional work – as not now able to ref back to GP

  23. PT audit results • “ The whole experience of PT direct has improved my assessment skills, it has however been harder work due to the higher levels of complex patients. I have also needed more time for communication with GPs.”

  24. Future developments • Roll out to St Neots Nov 03, St Ives ? Jan 04, other GP surgeries ? March 04 • Extension of opening of telephone line ?8.00am – early evening, ? Saturdays • Advertising and promotion, education of users and GPs • Research funded by professional body • Interest from the StHA roll out to rest of region • Part of DOH project group - role of AHPs in moving work from secondary to primary care

  25. Future Development of Physio Direct Patient Pathway (end of 2003/early 2004) Patient Discharge GP Physio Direct PCT Orthopaedic Panel Physiotherapy Extended Scope Practitioner Hospital Consultant Consultant Physiotherapist

  26. The last word from the patient…….. • “ This service encouraged me to seek advice, which otherwise I would not have done. I intend to seek advice again on another problem: this I would not do if I had to visit the doctor. To the likes of me this service is invaluable.”

More Related