Practical guidance

Are you thinking of self referral?

For developing self-referral, an excellent website to start is www.selfreferralphysioinfo.com. Developed by the Scottish Research team, it includes information on:

Setting up self referral, including all the relevant documentation, available for downloading
Publications and presentations
National and international research
Self referral anticipated referral calculator.

There is also a book, Patient Self Referral: a guide for therapists (authors Drs Holdsworth and Webster), available from the Self Referral Physio Info website or directly from www.radcliffe-oxford.com. The book takes the user through the process of service development. It is extremely user friendly, (the authors being experienced in clinical practice, research, quality improvement and management) the format including frequently asked questions and top tips.

Issues to consider

There are many different issues when considering self referral, and it is important that all the relevant ground work and planning is undertaken.

This must include:

an understanding of the local population
a comprehensive knowledge of key facts and evidence set out in a site descriptor (36Kb PDF).
a commitment to involving and listening to patients
developing a good network of contacts
learning from others.

Two publications, which will assist you in the process of service development and service re-design:

Scottish physiotherapists delivering for healthcare (2006), which includes a comprehensive self assessment check list for developing or re-designing services
Making the business case (2007) which aims to help physiotherapists get to grips with the commissioning process.

Practical advice from physiotherapists who have developed self-referral

Preparation

Engage and involve all staff in the process
Review and update your systems of administration, and data collection
Know your capacity and referral rate
Reduce any long waiting lists before embarking on self referral as this will discourage patients from referring themselves.
Be prepared for a slow start and then a sudden rise in referrals
Work with all key stakeholders to develop shared guidelines, care pathways and protocols
It is important to ensure that if patients use a form to refer themselves, the form can pick up red flags and other problems to ensure that patients in need of more urgent attention are not missed whilst sitting on a physio waiting list. A well designed form will often give you more useful information than a routine GP referral. It is vital to contact any patients who look as if they may have red flags by phone immediately. Examples of forms used by some of the Scottish sites can be found on www.selfreferralphysioinfo.com.

Communication

Communication with the GP practices is the most important area we have had to work on. Regular meetings, case discussions, updates and reviews are vital to allow for the smooth running of self-referral. This helps to develop a consistent and unified approach to the management of patients.
Spend time working with GPs to ensure you are both giving the same advice. A role in positive health messages, advice and medication may be all that the patient requires. Also advise as to screening and best practice management of patients and what physiotherapy has to offer
Develop good relationships with other appropriate services eg, in England, musculoskeletal interface (CATS) service. This has enabled prompt referral on of patients who needed more specialist support and investigation.
Listen to patient’s interpretation of their problem and beware of using jargon

Marketing

Advertise through the GP news letter or put flyers in with patient’s repeat prescriptions.
Ensure the new service is advertised well so patients will know about self referral before they see their GP. I think most of our referrals are GP suggested so all it is really doing is saving the GP paperwork and not true self referral