Scotland

Redesign of NHS Forth Valley´s Community Rehabilitation AHP Single Point of Referral.

NHS Forth Valley Community AHP services have redesigned how they deal with referrals received into their services. Until recently, point of receipt of referrals was purely administrative, with staff signposting to various parts of service that are delivered. Referrals that were deemed “inappropriate” were often lost in the system; there was no cognisance of how these “inappropriate” referrals should be dealt with. There was no understanding of time spent dealing with these queries. We redesigned the service, 'going live' in November 2018, to bring clinical staff into SPR, triaging the referrals received using a Personal Outcomes Approach and have reduced the number of referrals going forwards for intervention at the rehab teams, and increased signposting and self management in the community. This has had a knock on effect to reducing waiting times and enabled a more specific and tailored approach to those requiring rehabilitation in the community.

Advanced Physiotherapy Practitioner consultation as an alternative to GP consultation for patients with Musculoskeletal Conditions

General Practice is currently experiencing considerable capacity and sustainability challenges. With General Practice carrying out 90% of patient contacts in the NHS and musculoskeletal (MSK) conditions accounting for 10 - 30% of GP appointments it is essential to explore new ways of coping with this demand.

In Midlothian, half the practices were operating with restricted lists as a result of increasing demand: a demand which is predicted to quickly rise as the influx of new housing has resulted in Midlothian being the fastest growing local authority area in Scotland.

The strategic principle of this work is therefore to redirect appropriate patients from General Practice to MSK APP services with the aim of:

•           improving GP capacity.

•           improving patient outcomes.

•           improving the patient experience.

•           being cost effective and efficient.

•           enabling quick and easy access to highly specialised musculoskeletal input.

•           reducing referrals to secondary care, helping throughput and improving the conversion rate to surgery.

Developing a Physiotherapy Foot Surgery Service and Patient Pathway

The foot surgery service was expanded in order to undertake more complex foot surgeries, this required an increase in physiotherapy input. Adaptations were made to our provision of physiotherapy to accommodate patients undergoing complex foot surgeries, patients with multiple co-morbidities and patients with complex social needs. This incorporated developing a robust protocol-led pathway including pre-op education and assessment with the aims of increasing attendance of our pre-op assessments “Foot School” and reducing length of stay (LOS).

On Your Marks - Are PDRU Patients Meeting Government Exercise Guidelines?

The primary aim of the project was to review current practice and establish if our client group were meeting government exercise guidelines whilst attending the Physically Disabled Rehabilitation Unit (PDRU). In addition data was collected in relation to compliance rate of 1Repetition Maximum, exercise completion and recording of BORG RPE scores to determine intensity of treatment.

Supported Exercise programme for Adults with Congenital Heart disease (SEACHange)

Congenital heart disease is a lifelong condition. Many patients will require repeated open heart surgeries during their lifetime and others may go on to develop heart failure, arrhythmia or other problems associated with acquired heart disease. The benefits of regular exercise are well known. The overall aim of this pilot study is to determine the feasibility of introducing a supported exercise programme in to clinical practice to support physical and psychological well being in adults with congenital heart disease living in Scotland.

Multimorbidity Rehabilitation- The Sustainable Way Forward

Recognising that there is limited funding for “doing more of the same” we looked at how we could increase our cardiac rehabilitation capacity by broadening our scope and expertise to encompass a range of long term conditions that cause a high impact on unscheduled care. We acknowledged that multi-morbidity is becoming increasingly prevalent.

We subsequently developed The Healthy and Active Rehabilitation Programme (HARP) and opened up referrals to include people affected by stroke, cancer, COPD, falls, diabetes, and other long-term conditions.  HARP enabled us to widen our rehabilitation capacity to include cardiac groups which are typically excluded due to resource limitations: angina, arrhythmias and devices.  We designed a programme that would embrace activity, self management and support lifestyle change, across all of these groups.

Thus, the overall aim of this project was to proactively support prevention and self-management in an ageing population with increasing prevalence of chronic multiple morbidities. To help reduce health inequality the project has specifically targeted deprived and rural communities.

Secondary objectives 

  • To develop an evidence base for multimorbidity rehabilitation that would support a new way of working
  • To prove that this new model was sustainable

Student-Led Neurological Rehabilitation Group

Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to exercise. This study used a mixed methods approach to evaluate participant experiences and outcomes following participation in student-led, community-based neurological groups and to explore the feasibility of performing a full-scale study.

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