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

Purpose

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.

60% of patients seen had no prior GP face to face appointment
for the same condition.
95% of patients were seen in less than 1 week.
High levels of patient satisfaction were recorded.
Waiting times within core MSK physiotherapy reduced
from 39 weeks to 8 weeks.
Low onward referral rates were noted,
with up to 90% of cases being managed in Primary Care.

Approach

Patients were offered a 20 minute brief intervention appointment with the MSK APP as an alternative to a GP appointment.

Patients accessed the service in one of four ways:

  • Triaged from reception and seen in a first contact appointment with the MSK APP.
  • Seen by a GP first or telephone triaged by a GP, then booked in with the MSK APP.
  • Already on the waiting list for core MSK physiotherapy and looking for advice from the MSK APP while they wait.
  • A small number were seen as return appointments.

Quantitative and qualitative data was collected and evaluated.

Outcomes

In our first 11 months:

  • 3669 appointments were made with the MSK APP team.
  •  60% of patients seen had no prior GP face to face appointment for the same condition.
  •  731 hours of GP time was redirected to the MSK APP team.
  • Low onward referral rates were noted, with up to 90% of cases being managed in Primary Care.
  • 95% of patients were seen in less than 1 week.
  • Waiting times within core MSK physiotherapy reduced from 39 weeks to 8 weeks.
  • High levels of patient satisfaction were recorded.

Musculoskeletal Advanced Physiotherapy Practitioners can successfully work as first contact practitioners within Primary Care as an alternative to a GP for patients with musculoskeletal conditions.

Implications

As our service is still in the implementation phase, the full impact is not yet known - however our early data suggests that MSK APPs within the Primary Care setting are cost effective and efficient, improve the patient pathway, allow quick access to highly specialised MSK input, reduce secondary care referrals and improve GP capacity.

In the long term, it is hoped that this early intervention and quick access to MSK assessment, diagnosis and management will have a positive impact on reducing MSK complexity.

Top three learning points

  1. Start small and allow things to grow and develop naturally – don’t force a direction.
  2. Remember that healthcare is ever changing – what is right now might not be right in 6 months time - so be flexible and open to new directions.
  3. Recruit the right staff with the right knowledge, skills and behaviours – this combined with a shared vision and shared values makes life considerably easier. Be clear on roles, remits and lines of governance and accountability. 

Fund acknowledgements

Midlothian HSCP

Additional notes

This work was presented at Physiotherapy UK 2019 and at NHS Scotland Conference 2019.

Please see the attached Innovations poster below. 

For further information about this work please contact Debbie Crerar.  

From January 2020, we have offered this service in every GP practice in Midlothian. Covid - 19 seen our service temporarily withdrawn as the staff were deployed into essential services to ensure our Health and Social Care Partnership was in a position to manage the Covid – 19 pandemic workload appropriately. We have now reinstated the service in all our GP practices making use of digital options where possible.