1. 18 Week RTT – MSK Event Judith Park, General Manager for Surgical and Critical Care

2. Programme for the Day TimeItemLead & Session Outline 10.00 – 10.15Welcome & Overview of the Programme for the Day Judith Park, General Manager for Surgery and Critical Care 10.15 – 10.45Introduction of Patient Advice Line Ruth Currie, Senior Physiotherapy 10.45 – 11.45Development of MSK ModelJ Thompson, Consultant Physiotherapist MSK Services 11.45 – 12.00Questions 12.00 – 12.45Lunch & Networking 12.45 - 13.45Moving Forward E clinic, national pilot J Thompson, Consultant Physiotherapist MSK Services 13.45 – 14.00CloseJudith Park, General Manager for Surgery and Critical Care

3. SELF REFERRAL TO PHYSIOTHERAPY RUTH CURRIE PHYSIOTHERAPY TEAM LEAD

4. BACKGROUND 2007/8 – Physiotherapy waiting lists across NHS Lanarkshire inequitable. Varying from 3-4 weeks in some sites to 36 weeks in others NHS L had never introduced self referral to Physiotherapy in any format

5. AIMS To create equity in waiting times across NHS L To reduce waiting times for physiotherapy across NHS L To increase access to Physiotherapy To offer advice and enable some to self manage their condition

6. THE PILOT PHASE An 18 month preparatory phase in 2008/9 to reduce waiting times and waiting lists Temporary staff employed for 18 months A 6 month trial of the a telephone self referral service to Physiotherapy in 2 locations – Clydesdale (rural) and Motherwell (urban)

7. THE ROLL OUT JANUARY 2010 PHYSIOTHERAPY ASSESSENT LINE (PAL)

8. Monday to Friday 9am – 12 noon Open to all adults who live in Lanarkshire who have a musculo-skeletal problem for which Physiotherapy advice or intervention may be of benefit

9. Patients must be : Able to communicate via the telephone Present to give their consent Be available for assessment within office hours If not, a GP referral may be more appropriate

10. THE SYSTEM Telephone system Computer database Experienced clinicians

11. TELEPHONE SYSTEM A single telephone number for every Lanarkshire resident to use 01236 713901 Through an English based Telephonetics system No queuing A voice mail option Up to 30 incoming telephone lines

12. COMPUTER BASED SYSTEM An electronic physiotherapy assessment Linked in with CHI so demographics can be pulled down for Lanarkshire residents A clinical based assessment tool The telephone assessment takes on average 10 – 15 minutes

13. EXPERIENCED CLINICIANS All band 6 and 7 MSK physiotherapists Some band 5 Physiotherapists who had at least 2 years MSK experience with sound clinical reasoning skills and well developed communication skills Over 60 physiotherapists currently involved

14. TRAINING PROGRAMME –1.5 hour teaching session with PAL manual and introduction to the IT system –A 1.5 hour mock call session –A 1.5 hour supervised call back session Then Go Live!

15. VOICE MAIL Computer based secure call back site for all voicemails SLA is to call back those who leave a message within 2 working days X2 attempts made to reach the patient Voice message left

16. A TYPICAL DAY 9am – 12 noon : up to x10 physiotherapists ‘live’ Each physiotherapist can take between 10 and 15 calls 1.30pm – 4.30pm : up to 3 physiotherapists on ‘call backs’

18. CALL OUTCOME Self Manage and Discharge Routine Appointment Urgent Appointment Emergency Referral to A&E Information only Advised GP visit Salus – Health for Employability Salus – Working Health Services

19. Self Manage and Discharge Option to -Send some simple evidence based exercises for specific joints/ conditions -Direct to evidence based web pages -Information can be sent via email (non reply email address for PAL) -Ask to call back within a specific time period if no or limited improvement

20. Appointed patients Referral sent electronically to our 26 MSK sites and downloaded daily Each department follows the same MSK prioritisation criteria Routine – within 9 weeks Urgent – within 5 working days

21. Emergency Referral Any patient who, through the clincial reasoning process, is identified to be suffering from a condition which may require immediate medical attention (eg: cauda equina) Physiotherapist phones ahead to A&E and speaks to the receiving registrar.

22. Information Only Enquiries regarding uplift or return of equipment, appointment times, referral processes, etc

23. Advised GP visit To discuss medication / pain control For a written referral if communication not possible via the telephone For outcome of investigations

24. Salus – Health For Employability For those who are unemployed and who have a health condition which may be preventing them from accessing employment or training A case management approach

25. Salus – Working Health Services Private Physiotherapy provided for those who are self employed or who work for a small business of less than 250 employees.

26. 2010 Data Incoming calls – 31,488 Calls answered – 12,230 Completed Assessments – 11,688 Referrals to Physiotherapy - 8621

27. 2011 Data to end September Incoming calls – 31,947 Calls answered – 13,751 Completed assessments – 12,814 Referrals to Physiotherapy - 9151

30. DATA FOR PERIOD JANUARY 2010 TO JULY 2011

38. The Benefits of Self Referral to Physiotherapy PAL

39. Benefits to the Patient Immediate access to Physiotherapy advice Experienced clinician with sound clinical reasoning skills Access to electronic or paper based advice and exercise An alternative method of referral

40. Benefits to the GP -PAL business cards available in all GP practices -Less time consuming than writing or dictating a written referral -Cost effective -Places the onus on the patient to initiate the referral

41. Benefits to Physiotherapy Service More accurate information on the referral Patient usually already commenced some home exercise or advice A percentage self manage Reduced inappropriate referrals Reduced NP : Return patient ratio Equitable waiting lists and times

42. The Challenges Answering all our incoming calls Coping with computer crashes Staff absence / holidays Balancing time on telephone assessment with 1:1 patient assessment and treatment

43. The Future NHS 24 Janie Thomson