1. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 1 Physio Direct North Staffordshire PCT Elaine Wiltshire, MCSP, Dip MDT Clinical Specialist Physiotherapist.

2. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 2 Physio Direct Why was it necessary to change? Commission for Health Improvement (2003):  Complete a clinical effectiveness strategy appropriate to the needs of the population 10 Key Roles for AHP’s, NHS Plan (2003):  “…being a first point of contact for patient care”. Improving Working Lives.  Waiting Lists are too long (NSF)  93 % of Ortho. referrals LBP N.Staffs inappropriate (gov. sub com 2003)  25 % of GP consultations are musculoskeletal in nature.  88% people would rather self refer to physio (YouGov 2003)

3. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 3 Physio Direct Access Service  New method of service delivery  Needed to look at other methods of delivery of service due to very high waiting lists, high DNA rates in many Physio Depts.  Already being used in other areas of the UK (Huntingdon, Cheltenham, Northallerton and many more NHS Trusts)

4. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 4 Physio Direct Access Service  Service commenced September 2005 in Staffordshire Moorlands PCT  Initially only with one GP Practice  Serving all 16 GP Practices in the PCT by early July 2006  Patient Population of 120,000

5. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 5 Physio Direct How does it work here?  GP recommended (or from within the Practice) or Self –referred.  No written referrals from GP for this population of musculoskeletal out- patients

6. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 6 Physio Direct Access Service  Which Patient Population does this serve? Musculo-skeletal patients only - Musculo-skeletal patients only - Over 16 years old - Able to talk to NHS Physiotherapist on the phone  Any Exclusions? - Non Musculo-skeletal problem - Under 16 years old - Deaf or difficulty with English language - No Third Party callers (must be the patient) - Patients who need Domiciliary visit by Physio

7. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 7 Physio Direct Access Service  All are Senior Physiotherapists (Band 6 or above) on the phone lines  Additional training for the physiotherapist  Each do 1-3 sessions per week  1 Session = 2 hours  Remaining time is spent in their usual work place. (essential so skills are maintained)

8. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 8 Physio Direct Access Service  GP recommendation and self-referral to the service  Average call length = 20mins  Average number of calls per day = 20-25  Open from 8.30am - 4.30pm Mon-Fri  2 phone lines open  Answering Machine takes calls if both lines are busy then we call the Patient back (usually same day or within 24hours)

9. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 9 Physio Direct Access Service  Physiotherapy Assessment is done on the Telephone  Options following Triage: *Advice Only (advice sheet sent to patient) *Advice and Exercises (written materials sent) *Out-Patient Physio Appt. (made by the Physio) *Advised to see GP/A&E/Other *Pt may choose not to do the telephone triage so put on the routine waiting list for Physio Appt.

10. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 10 Physio Direct Access Service

11. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 11 Physio Direct Access Service

12. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 12 Physio Direct Access Service

13. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 13 Physio Direct Access Service

14. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 14 Physio Direct Access Service  Total number of calls since Sept 2005 = 6000 +  98% of calls go through Triage  20% of callers are referred to Out-Patient Dept  Average telephone call length = 20mins  (Out-Patient Appt, new assessment = 40 mins)

15. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 15 Physio Direct Access Service  Do we pick up Red Flags? Yes; Percent of patients with 4 Red Flags in Red Flag Hierarchy = 0.9%

16. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 16 Physio Direct Access Service Impact on Physio Services  Waiting Lists;  Rates of DNA;  Students;

17. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 17 Physio Direct Access Service Waiting Lists.  Significantly reduced; Sept 2005 waiting lists of 30+ weeks Currently 2-3 weeks on average, some physio depts have no waiting list. (This is in spite of job vacancies/frozen posts)

18. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 18 Physio Direct Access Service DNA rates  Significantly reduced, was 30-40% in some locations. Now consistently less than 10% (Many locations it is 0)

19. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 19 Physio Direct Access Service Students;  Some difficulty finding placements due to different patient complexity coming to the Dept. Many simple cases are managed on phone only.

20. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 20 Physio Direct Access Service Costs  Need headsets  Phone-lines  Physiotherapists (X10, not WTE, to cover our sessions)  Admin help (X 2WTE)

21. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 21 Physio Direct Access Service Difficulties  Resistance to change by some staff  Students, harder to provide places for students as the patients seen in Dept are more complex, and students can only observe telephone sessions, not provide.

22. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 22 Physio Direct Access Service Achievements  Improved patient access to physiotherapy  Reduced waiting times  Allows patients to self-refer  Offers timely advice including exercises and education to help with early recovery  Improved communication with GP’s about physiotherapy management for their patients

23. July 2007 Elaine Wiltshire, Clinical Specialist Physiotherapist. NSPCT 23 Physio Direct Access Service Plans for Future  Expansion of Physio Direct Service into Newcastle (North Staffordshire PCT)  ? Link in to Interface Clinics (Primary  Secondary Care)