Acute care

One of the most significant contributions physiotherapy can make to improving acute care is to ensure that patients can gain prompt access to the service appropriate to where they are on the trajectory of care. Physiotherapy is provided across a wide and disparate range of settings enabling greater degree of personalisation and access than many other clinical services.

Case study - Patient self referral

The recent work on self-referral to physiotherapy in the Department of Health funded pilot projects in England has identified the positive benefits of such systems. In one service, as a result of patient self-referral to physiotherapy, waiting times have plummeted from 20 weeks to 3 or 4 while urgent appointments are seen within 48 hours. Not surprisingly patient satisfaction has substantially increased. Data suggests that the majority of patients are managed within the physiotherapy out-patient clinic, with only 1% needing to return to their GP for further specialist support. Some 75% of patients only required one or two physiotherapy sessions, with over 50% saying they were completely better or significantly improved as a result of their consultation. One-third indicated that their condition was largely unchanged.

Maximising the use of appropriate self-referral or direct access, particularly in the management of musculoskeletal problems prevents the ‘merry-go-round’ between GP, consultant and physiotherapist that many patients suffer in seeking treatment for commonly encountered musculoskeletal problems. In the Somerset pilot some 38% of service users were over 65 years of age and 70% of these had problems of at least 3 months standing, 50% being spinal problems.

If this scenario is extrapolated, a 20-week wait for a first appointment for help with a spinal problem may incur the development of other concurrent musculoskeletal problems. Such complex co-morbidities may result in a greater need for other expensive health and/or social care support services. By investing resources to manage the problem at source and empowering the patient to live with their problem and prevent further problems developing, the economic argument for self-referral is irrefutable. Over 90% of those seeking treatment through the self-referral pilot agreed that physiotherapy offered effective treatment for musculoskeletal problems and a similar proportion felt that patients could learn a lot about managing their health problems.

Similar innovative services in Scotland also found that self referrers were better attendees, became better quicker and were absent from work in lower numbers and for fewer days. The average cost for a self-referred episode of care was 25 percent less than those referred by a GP.