A specialist fitness for work service: Advanced practice physiotherapist working as a first point of contact practitioner

Purpose

An advanced practice occupational health physiotherapist introduced a new fitness-for-work service to manage clients with work- related or impacting musculoskeletal disorders. The purpose was to shorten waiting times for clients to access specialist physiotherapy, reduce the number of referrals to GPs, OHPs and OHAs and secondary care, reduce sickness absence and improve productivity, and maintain excellent service user satisfaction.

£3140 per client
Net cost benefit generated by the fitness for work service is per client, representing a 1:15 return of investment

Approach

The service is staffed by a 1.0 Band 7 WTE APP who manages the whole clinical pathway including triage, assessment, treatment, fitness-for-work assessments, and case management. This service allows clients to self-refer directly into the service, and accepts management referrals. Traditionally, GPs, OHPs/OHAs and managers were the gate keepers and would refer employees for physiotherapy or secondary care for further investigations. The innovative aspects of this new service included self-referral to a first contact APP thereby avoiding GP or OHP/OHA consultations or management referral, and links to secondary care for direct listing of clients that required further investigations.

Outcomes

Appointments over a 12-month period totalled 574 new patients with a total of 933 contacts.

  • 72% of clients required self-management and discharge
  • 71% self-referrals
  • 29% management referrals
  • > 94% of those off sick advised to return to work
  • 37% received workplace assessments
  • < 3% cancelled/failed to attend appointments
  • < 1% referrals to GPs/OHPs/OHAs
  • 98% of clients and 94% of managers reported satisfaction with service
  • Waiting times reduced from 5 months to < 5 days

Financial results: Net cost benefit generated by the fitness for work service is £3140 per client, representing a 1:15 return of investment

Cost and savings

We conclude that the advanced practice physiotherapist working as a first point of contact practitioner in a specialist fitness for work service reduced waiting times to access physiotherapy, reduced referrals to GPs/OHPs/OHAs and further investigations, improved client and manager satisfaction, and is cost-effective with a 1:15 return of investment.

Implications

This pragmatic evaluation of the specialist fitness for work service indicated that is likely to be feasible in terms of service usage and cost-effectiveness, and could be rolled out nationally to reduce sickness absence, improve productivity and reduce the financial strain on the NHS.

Top three learning points

  1. Robust data collection is required to benchmark current data to previous and new pathways.
  2. There is increasing evidence that specialist fitness-for-work services are cost-effective.
  3. Early physiotherapy contact for musculoskeletal disorders can improve health and work outcomes. 

Fund acknowledgements

This work was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2019

 

For further information about this work please contact Dr Laran Chetty.