Transcript Self Referral - Department of Health, Social Services and

Self Referral
Julie Shepherd
Lead Physiotherapist
Overview of presentation
•
•
•
•
•
History & evolution of local self referral scheme
Benefits
Implementation
Evaluation
The Future!
Key points regarding Self Referral
• Does not open the floodgates
• Is patient centred & encourages self
management/empowerment
• Enables timely access to advice/reducing chronicity
• Can prevent people going off work/get them back to
work
• Enhances therapists autonomy & management
strategies
• Can increase capacity by reducing new to follow up
ratios
• Saves GP time
• Can support long term conditions
GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST
New atts
Physio Outpatient New Attendances by Source of Referral: Trustwide
14000
12000
10000
8000
6000
4000
2000
0
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
Year
Self
Cons
GP
Other
2009/10
2010/11
Physiotherapy Outpatient new attendances
Source 2001/02 2002/03 2003/04 2006/07 2007/08 2008/09 2009/10 2010/11
GP
5083
9401
8827
9051
8093
8513
6998
7007
Consultant
3225
5840
4726
5522
6284
7306
8845
7647
Self
934
2210
3868
9997
11807
11850
11973
12584
Other
466
409
1358
3188
2775
3479
5508
5465
Total
9708
17860
18779
27758
28959
31148
33324
32703
% self
9.6
12.37
20.59
36.01
40.77
38.04
35.92
38.47
Local implementation milestones
• 1991 - Established in East Gloucestershire
Trust, stopped with the introduction of GP
Fundholding in 1995 & then re-established in
1998 with the demise of GP Fundholding & the
emergence of Primary Care Groups
• 2000 – Staff self referral at Cheltenham General
Hospital
• 2001 – ‘Physio Direct’ telephone access
• 2010 – ‘Drop in’ clinics
Staff Self Referral
• 341 patients seen in the first year (2000)
• New to follow up ratio 1: 1.4 compared to
department average of 1: 3.4
• Anecdotally – patients more self motivated &
happy to self manage
• Commended by a Health & Social Care Award
2001 “Improving the lives of staff” category
‘Physio Direct’
• A ‘trial’ which commenced in November 2001
with 3 GP practices (1 hour per day, Mon-Fri)
• Extended in 2002 (3.5 hours per day) to cover 6
practices in total (population of 53,000)
• Extended in 2005 to cover all GP practices
within Cheltenham (from 9.00am to 4pm)
Key Objectives
• Provide telephone access to people to ensure timely
advice/intervention is given
• Empower people to self manage their condition
• Provide a new service within existing resources
• Demonstrate that demand and capacity can be managed
in a different way
• Reduce administration and save time for GPs
The Pathway
• The patient can self refer via the telephone
following the process outlined on posters or in
the GP newsletter.
• Alternatively if the GP feels that his/her patient
requires physiotherapy, the GP tells the patient
to contact Physio Direct.
• The patient phones the physiotherapy
department at the designated times to speak to
a Physiotherapist.
The Pathway
• Assessment by asking a series of questions,
leads to one of the following outcomes for the
patient:
• Advice including an exercise sheet (post or email) and/or information leaflet or
• An appointment to see the physiotherapist or
• Referral to their GP if a medical assessment
is indicated.
How the scheme was managed
• All parties agreeing clear objectives and measures
• Involvement of all staff delivering the service from the
outset
• Working with PCT “Access” leads and GPs
• Making changes as needed and testing to ensure added
value
• Starting small and building a system based on measured
success
• Evaluation and feedback to all involved
‘Red Flags’
In the first year, 3 patients were fast tracked with
the following problems:
• Pathological fracture of C7
• Fractured pubic ramus
• Child with an avulsion fracture
Evaluation
• Questionnaire surveys were sent to participating GPs
and patients who had been managed by Physio Direct
and had been discharged from the service at 3 months
and 14 months.
• A response rate of 92% and 64% (3 months), 87% and
58% (14 months) respectively was achieved.
Of the sample of patients surveyed:
• 71% of patients reported that they felt more in control of
their symptoms
• 69% of patients had not consulted elsewhere
• 88% felt that the service should continue
Analysis of the activity data Nov 2001-Dec 2002:
820 patients called Physio Direct
• 40% of those were managed with advice and
exercise sheets/information leaflets only
• 60% of those visited the local Physiotherapy
Department for follow up intervention. Of those,
25% needed only one follow up appointment
• The average wait for routine referrals to the
department remained consistent at 7 weeks
Comments from service users
• “An easy quick way to have minor problems
solved”
• “Excellent way of getting quick advice. I have
previously had to wait weeks for an appointment.
I spoke to a friendly physio who listened and
gave me unhurried time. I needed reassurance
and was told I could phone again and be seen if
necessary and speak to the same person”
Comments from service users
• “I was very pleased with the service given. The
only piece of information I didn’t get was when to
stop the exercises”
• “Most of this is not relevant to me, as the physio,
hearing of my problem took me to A&E where a
crack in the bone was discovered. I was
impressed with the system. Many thanks to the
physio concerned”
Comments from service users
• “Physio triumphed where my doctor failed to
diagnose and treat”
• “The immediacy of consultation and advice was
a tremendous improvement on previous referrals
to physio with the traditional long wait for
treatment/advice”
• “Reassurance and professional pain
management helped alleviate the stress and
anxiety and prevented non-useful visits to the
GP”
Comments from service users
• “It took some 5 hours on the phone, over 2
weeks to at last get in touch with the Physio”
• “I feel that it is necessary for the Physio to have
a diagnosis of the problem, either from the GP or
Consultant”
Comments from GPs
• “Patients very happy with the service and I have
had very good reports from those using it. Saves
an enormous amount of time in admin and
unnecessary referrals to yourselves. Thank you”
• “The scheme seems to be working well. I have
had positive feedback from patients, both from
those that get advice and leaflets in the post and
those who get appointments”
Comments from GPs
• “Of great assistance and simpler than direct
booking which wasted staff time”
• “Very helpful service P.S. good questionnaire –
short brief and to the point”
• “Excellent++++”
• “Greatly reduced admin, so please continue”
Current methods supporting self referral
• Telephone eg ‘Physio Direct’ & follow up
consultations
• ‘Paper’ Self referral form (including preassessment form)
• On line referral: Re-vamped website
• ‘Drop in’ clinics
Learning through implementing Self Referral
• Does not open the floodgates
• Enables timely access to advice/reducing chronicity
• Can prevent people going off work/get them back to
work
• Is patient centred & encourages self
management/empowerment
• Enhances therapists autonomy & professional
responsibility
• Can reduce DNA rates and new to follow up ratios
• Saves GP time
• Can support long term conditions
• Gives confidence to take on new ways of working –
development of ‘drop in’ clinics
What you need:
• Passion for change & to take a ‘risk’
• Staff involvement from the outset in planning &
implementation
• Self management philosophy
• GPs on side
• Start small and build in ‘bite size’ chunks
• Tailor it in regard to your population & feedback
• Other helpful resources - Self Referral
Implementation tools: www.csp.org.uk
The future?
Increased usage of technology to communicate
with patients
• e-mail
• ?SKYPE
• ?Twitter
• ?Blogs
References
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Holdsworth LK, Webster VS, McFadyen AK, et al. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a
national trial. Physiotherapy. 2007;93(1):
Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP
services. London: Department of Health; 2008. p 9
Chartered Society of Physiotherapy. Proceedings of Council: byelaw amendments. Physiotherapy. 1978;64(7):218.
Department of Health. The NHS in England: The operating framework for 2009/10. London: Department of Health; 2009.
Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP
services. London: Department of Health; 2008.
Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP
services. London: Department of Health; 2008. p 15
Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP
services. London: Department of Health; 2008. p 16
Black C. Working for a healthier tomorrow. Dame Carol Black's review of the health of Britain's working age population. London: TSO;
2008. p 76
Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP
services. London: Department of Health; 2008. p 18.URL:
Department of Health. The patient's charter. London: Department of Health; 1991.
Holdsworth LK, Webster VS, McFayden AK. Direct access to physiotherapy in primary care now and into the future. Physiotherapy.
2004;90(2):64-72.
Department of Health. The NHS in England: The operating framework for 2009/10. London: Department of Health; 2009. p 16
Department of Health. The NHS in England: The operating framework for 2009/10. London: Department of Health; 2009. p 13
Black C. Working for a healthier tomorrow. Dame Carol Black's review of the health of Britain's working age population. London: TSO;
2008. p 76
Darzi A. High quality care for all: NHS Next Stage Review final report. Cmd 7432. London: Department of Health; 2008.
Scottish Executive Health Department. Building on success: Future directions for allied health professions in Scotland. Edinburgh:
Scottish Executive; 2002.
NHS Scotland. Better health, better care: action plan. Edinburgh: NHS Scotland; 2007.
Scottish Executive. Co-ordinated, integrated and fit for purpose: a delivery framework for adult rehabilitation in Scotland. Edinburgh:
Scottish Executive; 2007.
Sturgeon N. Scottish parliamentary questions: written answers Tuesday 3 November 2009 Edinburgh: Scottish Parliament; 2009.
NHS Lothian. NHS Lothian at the cutting edge (press release). Edinburgh: NHS Lothian; 2009.
Welsh Assembly Government. A therapy strategy for Wales: the contribution of therapy services to transforming the delivery of health and
social care in Wales. Therapies for modernisation. Cardiff: Welsh Assembly Government; 2006. p 5
Bookmark/Search this post with:
"If you always do what you've always
done, you'll always get what you've
always got."
For further information please contact:
[email protected]