Access to services
Key Points
Physiotherapy is widely available across the UK, but accessing these services has often presented challenges for some groups.
People with disabilities, those living in isolated areas, and people who work long hours are just some of those who may find it difficult to visit traditional physiotherapy clinics.
Today, higher patient expectations, combined with a growing readiness for innovative service design, are presenting an opportunity to make services more accessible to patients, often increasing efficiency in the process.
- Providing services centred on individual need. There is a growing understanding that services should be 'wrapped around the patient', rather than 'wrapping the patient around the services'. Individuals are playing an increasingly proactive role in managing their own health, and have a clear idea of what they expect from their services.
Taking a proactive approach to designing flexible, responsive services, within acceptable waiting times, results in better outcomes all round – not least in patient satisfaction. For example, providing out-of-hours appointments enables people to access physiotherapy without having to take time off work, resulting in positive health outcomes for the individual and wider economic benefits. - Promoting equality. Equality and diversity is protected under a range of legislation. For example, under the Disability Discrimination Act 1995 (amended 2005) Section 21: Access to goods, facilities and services, practices are required to make 'reasonable adjustments' to ensure that people with disabilities are able to use their services. This may include making physical adaptations, such as replacing steps with ramps, as well as redesigning systems by offering initial assessments by phone, or ensuring translation services are available.
- Tackling local health inequalities. We have seen a shift towards empowering local services to direct funding to their areas of need, championed by initiatives such as world class commissioning. This focus enables services to target their resources at the groups in most need of treatment. Initiatives such as direct access and telephone advice enable practices to provide initial assessments using minimal resources, so that remaining funding can be concentrated on those with greatest need. For example, projects have been developed recently to work specifically with farming communities to provide them with appropriate access to physiotherapy services.(1)
- Embracing innovation. There is a growing drive towards continuous quality improvement within the NHS, with an emphasis on providing an environment where innovation can flourish (for example, High Quality Care for All). One of the visions for the health service in 2022 as set out in the Wanless report Securing our future health is that "Current service innovations such as NHS Direct, Walk-in Centres and telemedicine are commonplace, enabling people to receive an initial diagnosis in a variety of settings, moving beyond the traditional visit to the GP surgery."(2)
The key innovations that practices are using to improve access to services include:- redesigning community services to become more responsive to patients' needs – for example, by extending opening hours, offering appointments at a choice of locations, and running drop-in clinics
- direct access to physiotherapy by self-referral to telephone triage and patient-management systems
- services such as NHS Direct and NHS24, which offer phone and web advice, along with simple tools for self-diagnosis
- telepractice – a range of electronic and assistive technologies used to support people at home and maintain independence. They include telecare (using technology to support individuals in their own homes, for example through monitors that detect falls), telehealth (remotely monitoring and managing conditions – for example, measuring a patient's heart rate through a sensor that transmits the results to an assessment centre) and telerehabilitation (for example, using videoconferencing following surgery to monitor patients and offer advice).
Resources
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Publication48 weeks ago
Implications
- The drive to increase access to services provides a range of opportunities for physiotherapy practices to engage with the populations they serve and develop new skills in order to embrace innovative ways of working. In one positive example, a project that identified a significant need for physiotherapy among farmers within its catchment area set up a joint nursing and physiotherapy clinic at the weekly farmer's market, where anyone could drop in for an assessment, and follow-up treatment or farm visits could be arranged.(1)
- Physiotherapy practices need an increasingly sophisticated awareness of the way they deploy resources in order to demonstrate value for money. In the current economic climate, it is more important than ever to make sure that services are cost-effective. Reconfiguring a service to offer greater flexibility is likely to result in a leaner, more effective service. For example, spreading treatment over extended hours will not increase costs in terms of staffing or premises rental costs, but may enable more people to be seen.
- Developments in the wider healthcare system affect the way people access physiotherapy services. Increased prescribing by nurses, pharmacists and physiotherapists themselves will all affect access, as will the growing emphasis on providing services in community settings. Physiotherapists need to play an active role to promote physiotherapy as a key component within these wider developments.
- A key aspect of access is waiting times. Each part of the UK has its own waiting times targets, and standardised data collection is important to enable practices to gather accurate data to show how long patients must wait between referral and treatment.
- Telepractice presents a significant opportunity to increase efficiency and cut costs. However, physiotherapists have not embraced these methods to the extent of their colleagues in the other allied health professions. Findings show that a wide range of technological tools can be used to enhance traditional physiotherapy and to help spread resources more effectively. For example, rehabilitation classes for people with chronic obstructive pulmonary disease have been transmitted by video link to patients living in remote rural areas, with positive outcomes.(8) There is a need to embrace these technologies and find ways to make them work for physiotherapy.
News & Comment
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Frontline article1 year ago
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News item1 year ago
Background
For almost two decades, since the Patients' Charter (3) was published in 1991, the NHS has been increasingly focused on providing flexible services that are better tailored to meet the needs of patients, rather than those of the professionals caring for them. In 2002, the Wanless report advised that 'patients are expected to want more choice in future and to demand higher quality services'.(4) Since then, we have seen a growing number of initiatives designed to empower patients to access the information or treatment they need, in the way they want it. They include Patient Choice, Choose and Book and NHS Direct/NHS 24.
Underpinning this shift is the raised level of public expectation within modern society. Today's public is better informed than ever before, with greater access to information about conditions and the treatments available – not least due to the internet. There is a trend to see patients more as consumers, or service users. People are more demanding. They expect a quality service, with reasonable waiting times, and are more likely to hold healthcare professionals to account. (5)
The result for physiotherapists and other allied health professionals is an ever-stronger emphasis on providing services in the way that best meets individuals' needs. This approach is often known as 'patient-centred care', but this can be a misleading term, as the services in question are not only for patients – particularly in the case of physiotherapy. Much physiotherapy goes beyond treating those with existing conditions to work with individuals to help them maintain good health or propose strategies for preventing problems, as well as working with those in caring roles to help them support the person with a condition.
Running parallel to this sea change is the increased awareness of the need to provide inclusive services that take into account the needs of underrepresented groups. These include people with disabilities, members of black and minority ethnic groups, gypsies and travellers, and those from low socioeconomic backgrounds, as well as people living in remote rural areas or with poor transport infrastructure. In Wales there is a commitment to provide all services in Welsh as well as English. These changes clearly benefit individual service users – but they benefit physiotherapists too, not least because they result in services that have a better uptake and improved patient satisfaction.
However, there has been resistance to taking up some innovations – particularly in the case of telepractice. There is robust evidence that telepractice can help people maintain their independence (see www.wsdactionnetwork.org.uk), and the government has repeatedly made the case for wider uptake, but very few physiotherapy services have taken up the opportunity to date.
A number of patients seek concurrent treatment from another physiotherapist or from another registered or non-regulated practitioner. The CSP has recently written an information paper to inform chartered physiotherapists with regard to their responsibilities to patient care in the event of a patient seeking concurrent treatment.(6) It gives physiotherapists guidance on the management of patients who seek alternative or extra treatment concurrently with their treatment.
The overall message is that new ways of working can enable physiotherapists to offer cost-effective flexible services that enable patients to live independently, which in itself improves outcomes. For examples, services offering patients the option to self-refer to physiotherapy have fewer missed appointments, and a higher chance of people completing a course of treatment. This means increased satisfaction for the individual – but also has many benefits for physiotherapy services and commissioners.(7)
Action Points
- Take some time to understand the key drivers in this field and how they impact on physiotherapy in your area. For details, see the section for your own country.
- Research the demographics of your local population and try to identify groups that seem to be underserved. People with mobility problems, communities with poor transport links and people who do not speak English as their first language will all have different needs in accessing physiotherapy.
- Take the opportunity to talk to the public, to local organisations and to other healthcare professionals working locally. What do they see as the greatest barriers that people face in accessing physiotherapy in your area?
- Think creatively about how to engage with the populations that have the greatest need. You may draw on a palette of small changes that will make a big change overall.
- Find out more about telepractice and consider how you could incorporate it into your work. You can find examples of good practice at: www.wsdactionnetwork.org.uk) or use iCSP
References
- Chartered Society of Physiotherapy. Making physiotherapy count: a range of quality assured services. Compiled as a part of the Sharing Effective Physiotherapy Practice Project. London: The Chartered Society of Physiotherapy; 2004. p 16
- Wanless D. Securing our future health: taking a long-term view. Final report. . London: HM Treasury; 2002. p 15
- Department of Health. The patient's charter. London: Department of Health; 1991.
- Wanless D. Securing our future health: taking a long-term view. Final report. . London: HM Treasury; 2002. p 6
- Darzi A. High quality care for all: NHS Next Stage Review final report. Cmd 7432. London: Department of Health; 2008. Chapter 2
- Chartered Society of Physiotherapy. Patients seeking concurrent treatment from physiotherapists or other regulated or non-regulated practitioners. London: The Chartered Society of Physiotherapy; 2008
- Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008
- Duthie A. Chronic obstructive pulmonary disease (COPD) remote rehabilitation classes via video link. Web article. Scottish Centre for Telehealth 2009
- Carlisle D. Remote revolution Frontline. 2008;14(15):16-9.
- Department of Health. Building telecare in England. London: Department of Health; 2005
- Department of Health. The NHS improvement plan: putting people at the heart of public services. London: Department of Health; 2004. p 4
- Department of Health. Our health, our care, our say. London: The Department of Health; 2006
- Darzi A. High quality care for all: NHS Next Stage Review final report. Cmd 7432. London: Department of Health; 2008. p 31
- Lakhani M. No patient left behind: how can we ensure world class primary care for black and ethnic minority people? London: Department of Health; 2008
- Scottish Executive Health Department. Building on success: Future directions for allied health professions in Scotland. Edinburgh: Scottish Executive; 2002.
- NHS Scotland. Better health, better care: action plan. Edinburgh: NHS Scotland; 2007. p 1
- NHS Scotland. Framework for role development in the allied health professions. Edinburgh: NHS Scotland; 2005. p 4
- Holdsworth LK, Webster VS, McFadyen AK, et al. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy. 2007;93(1):3-11.
- Beale S, Sanderson D, Kruger J. Evaluation of the telecare development programme. Final report. Edinburgh: the Scottish Government; 2009
- Scottish Government. Seizing the opportunity: telecare strategy 2008-2010. Edinburgh: Scottish Government; 2008
- NHS Scotland. The NHS and you: What can I expect from the NHS in Scotland? Glasgow: Health Rights Information Scotland; 2009
- Department of Health Social Services and Public Safety. Investing for health. Belfast: The Department of Health, Social Services and Public Safety; 2002
- Department of Health Social Services and Public Safety. A healthier future: a twenty year vision for health and wellbeing in Northern Ireland 2005 - 2025. Belfast: The Department of Health Social Services and Public Safety; 2004
- Department of Health Social Services and Public Safety. Strategy and action plan to promote equality, good relations and human rights. Belfast: Department of Health, Social Services and Public Safety; 2008
- Welsh Assembly Government. One Wales: A progressive agenda for the government of Wales. Cardiff: Welsh Assembly Government; 2007. URL:
- Welsh Assembly Government. Designed for life – creating world class health and social care for Wales in the 21st century. Cardiff: Welsh Assembly Government; 2005
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