Planned care

The 18 week wait initiative is one of the key drivers to service reform in the NHS in England. Physiotherapy could be making a major contribution to not only assisting trusts ‘hit the target’ but also substantially reduce the wait - and consequent pain and discomfort - for those patients not fortunate enough to fall within the administrative boundaries of the target. Through diagnosis, treatment and assisting the patient to manage the condition, physiotherapy is an oft overlooked resource within a predominantly medical model.

With over two million referrals a year to secondary care - 14 % of the total - and inpatient waiting times longer than any other specialty, orthopaedic surgery represents a major challenge to delivering 18 weeks. Orthopaedics has also been identified in the White Paper ‘Our health, our care, our say’ as a key area for providing more care closer to home. Physiotherapists will be central to tackling musculoskeletal problems, which account for around 30% of all orthopaedic referrals.

Case study (1) - Physiotherapy triage team

The team is having a big impact on orthopaedic treatment waiting times by cutting the number of patients referred for elective surgery by 70 per cent. Set up two years ago, the 10-strong team of skilled physiotherapists sees all patients that local GPs believe are suitable for elective orthopaedic treatment. All are seen within three weeks and most are now managed in the community through a combination of physiotherapy, joint injections and education and support. Many of these patients will eventually require surgery of some kind, but because of this intervention they will only be referred to secondary care at the point of real need, when they are fit and ready for surgery. The triage team is now working with other professions to provide a single point of entry for everyone in the area with musculoskeletal and rheumatological problems. It is also trying to tackle other potential bottlenecks in the patient pathway such as the wait for MRI scans (down from six weeks to a maximum of two) and for orthotic and surgical appliances.

Case study (2) - Back pain management scheme

This scheme has reduced the numbers of patients going on to the orthopaedic surgery waiting list by 85 percent. Two physiotherapists, available only two evening per week, found that only 2 percent of those patients on the consultant orthopaedic consultant waiting list required surgery. The remainder would have waited for around ten months before being referred by the consultant, mostly to physiotherapy. A similar scheme in Glasgow reduced the consultant waiting time from forty to six weeks.

Case study (3) - Musculoskeletal physiotherapy service

Patients had to wait up to 5 months for out patient musculoskeletal physiotherapy. Patients with acute musculoskeletal problems had little opportunity to receive appropriate advice or treatment when it could be most beneficial. A direct access telephone call service was implemented and a clinical physiotherapy triage system was set up so that all patients who telephoned for an appointment were given one within 2 weeks. The waiting lists are actively audited to maintain the current status of no wait. There is in built flexibility to allow more appointments to be made available if demand changes. The ‘no waiting list’ status has been sustained since September 2002, improving from 2 weeks to 48 hours with all patients accessing musculoskeletal physiotherapy able to use this service.