1 st Line Physiotherapy AHP Summit 2014 Rob Goodwin, Clinical Lead Physiotherapist, MSK Clinics Team

Introduction The drivers Political Historical Evidential Local The proposal The implementation

 Simon Stevens  Chief Executive of the NHS  Service pressures are intensifying, and longstanding problems are not going to disappear overnight. As my predecessor David Nicholson has pointed out, this year is going to be a challenge and 2015/16 even more so. No one person can fix everything that needs fixing – certainly not me. Successfully navigating the next few years is going to take a team effort – involving the biggest team in the biggest effort the NHS has ever seen. (April 2014) The Political Drivers

Improving general practice- A Call to Action (April 2014)  an ageing population, growing co-morbidities and increasing patient expectations, resulting in large increase in consultations, especially for older patients, e.g. 95% growth in consultation rate for people aged in ten years up to 2008/09. The number of people with multiple long term conditions set to grow from 1.9 to 2.9 million from 2008 to 2018;  increasing pressure on NHS financial resources, which will intensify further from 2015/16;  growing dissatisfaction with access to services. The most recent GP Patient Survey shows further reductions in satisfaction with access, both for in- hours and out-of-hours services. 76% of patients rate overall experience of making an appointment as good;  persistent inequalities in access and quality of primary care, including twofold variation in GPs and nurses per head of population between more and less deprived areas;  growing reports of workforce pressures including recruitment and retention problems. The Political Drivers

 Improving General Practice- A Call to Action (2014)  Phase 1 report  Better partnerships:  a more innovative approach to planning and delivering services by way of shared learning and ideas  Empowering clinicians:  ensuring high-quality support for innovation and improvement, developing networks to allow more rapid spread of innovation, supporting general practice in developing new models of provision, and releasing time for patient care and service improvement. The Political Drivers

 Previous papers:  Healthy Life's, Healthy People; Our Strategy for Public Health in England (2010)  Unleashing innovation and liberating professional leadership  Empowering local leadership and encourage wider responsibility to improve everyone's health and well- being The Political Drivers

 Previous papers  Equality and Excellence; Liberating the NHS (2010)  Moving commissioning to GP’s will mean redesign and patient pathways is always clinically-led  Autonomy for providers  Create the largest and most vibrant social enterprise sector in the world The Political Drivers

 ‘clinical specialists with an extended scope of practice i.e. working beyond the recognised scope of practice of the profession of interest in innovative or non-traditional roles’. Advanced roles

 Drivers associated with ‘modernisation’  Service redesign, staff and skill shortages, new health care technologies, improvements in quality, cost containment  Professional aspirations  Increased job satisfaction, autonomy in practice, role and career development Advanced roles

 Nursing  AHP’s  Meeting the Challenge- A Strategy for the Allied Health Professions (2000) Advanced roles

However, the role of the allied health professions has too often been undervalued or neglected. The Government is committed to changing this. The NHS Plan already sets out clear commitments to these staff, in particular that there will be, by 2004,  over 6,500 more therapists and other health professionals,  4,450 more therapists and other key professional staff being trained and  new therapist consultant posts And we are committed to expanding the roles which the allied health professions play in health and social care, ensuring they can use their skills flexibly and creatively to the benefit of patients. Advanced roles

 AHP’s  McPherson, K, Kersten, P et al, 2006  A systematic review of evidence about extended roles for allied health professionals Evidence for advanced roles

 McClellan CM et al, 2006  Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in a adult emergency department  Pearse EO et al, 2006  The extended scope physiotherapist in orthopaedic out-patients- an audit Physiotherapy advanced roles

 Reeve S and May s, 2009  Exploration of patient’s perspectives of quality within an extended scope physiotherapy spinal screening service  Kennedy DM et al, 2010  Patients are satisfied with advanced practice physiotherapists in a role traditionally performed by orthopaedic surgeons  Bath B and Janzen B, 2011  Patient and referring health care provider satisfaction with a physiotherapy spinal triage assessment service Physiotherapy advanced roles Patient and staff perceptions

 Stanthorpe J et al, 2012  Extended scope physiotherapy roles for orthopaedic outpatients: an update systematic review of the literature  Desmeules F et al, 2012  Advanced practice physiotherapy in patients with MSK disorders: a systematic review Physiotherapy advanced roles Systematic reviews

A local coming together Perceived local pressures Local MSK Physiotherapy developments Local relationships Clinical Leadership Innovative practice

GP burden

The Proposal Leverage!

Main cohort >400 patients 56 physiotherapy patients 54 GP patients Close co-operation meant no extra appointment for x- rays, blood tests etc Significant differences in patient satisfaction 6% referred to GP due to suspected ‘red flags’ 9% returned to see their GP with the same problem More patients had ‘complete confidence’ in physiotherapist than GP Physiotherapy group had better information about disorder and self care Physiotherapy group had greater self- efficacy

Realising the proposal Commissioning

 2 GP practices  2 half days clinics  Pre-launch training  Outcome measures  Evaluation 1 st Line Physiotherapy 20 minute appointments Maximum capacity of 9 new patients per clinic EQ 5D CARE Scale Patient satisfaction 1 month 6 months 1 year Qualitative evaluation

1 st Line Physiotherapy Questions