Like many acute Trusts across the country, the MSK, paediatric and pelvic health physio teams at Ashford and St Peters (ASPH) in Surrey were facing competing demands on rehabilitation space as a result of the pandemic. Building on the ideas they had to bring rehabilitation closer to home for patients before the pandemic hit, the team managed to successfully influence at all levels of local decision-making to secure gym space and clinic at 3 local gyms.
In this blog post they describe how they achieved this, how their influencing efforts snowballed and the positive effect on staff and patients. As a result of their efforts they even managed to secure the attention of their local MP, hosting a service visit during the pandemic in 2020 which resulted in an NHS Parliamentary Award.
Before the pandemic
The team had begun conversations 2 years prior and trialled a pilot at nearby gym River Bourne Health Club, providing exercise classes that the staff at River Bourne Health Club also worked to replicate, which was successful. The process of securing Trust board approval for the team re-location of patient exercise rehabilitation to the gym took only 4 weeks.
Gaining the finance for the gym project was relatively straightforward as the Trust could see the benefit of re-claiming space in the Hospital – particularly as the physio area was located near to A&E and acute services, it was always a challenge to accommodate this space against the competing demands of other patient services.
In July 2019 they opened services across MSK, pelvic health and paediatrics at River Bourne Health Club with the aim to de-medicalise patients. By encouraging patients to use River Bourne for their rehabilitation and to also facilitate self-management the Trust were able to utilise the former physio space at the Hospital to create a new 40 bed ward.
The patient feedback gathered between the summer of 2019 and March 2020 was good. By using a community gym space for their rehabilitation, patients were viewing it as exercise first and foremost, arriving in gym gear for their sessions and continuing self-management post therapy visiting the gym up to 4 times per week. For non-medical patients the gym setting as opposed to a Hospital setting changed their mindset from one of being ‘treated’ to one of being ready for exercise and to help them lead a more active lifestyle. This was mutually beneficial for the gym too, with an increase in membership.
For pelvic health the River Bourne setting was ideal. Pregnant and post-natal patients found the setting better for their treatment. Take-up of physio led classes was good and women had the confidence afterwards to continue with gym membership. They appreciated the community aspect to their treatment and the opportunity to socialise with other mums afterwards at the gym’s café.
After Covid hit
All the classes moved to virtual by the first week in April with ASPH working quickly to arrange the technology and enable remote-working for staff. This approach continued until August when restrictions eased and the team were able to deliver a hybrid model of virtual and face-to-face (6 patients virtual and 6 face-to-face according to patient need).
For pelvic health and paediatric teams, who were based on the Hospital’s ‘infectious’ site, there was an almost overnight change losing all their treatment space. They shifted straight to virtual treatment and classes and were able to deliver virtual classes all the way through with the aim longer-term to deliver hybrid sessions.
Given the situation the team decided to capitalise on their good relationship with the local gyms who had been hit hard by the pandemic not only because of loss of footfall from the public but also because of other services such as podiatry and acupuncture pausing their contracts. Therefore more space was potentially available.
The gyms kept open for the NHS so that face to face clinical care for individual treatments could continue. As a result the pelvic health team managed to catch up on a back log of patients requiring face to face care enabling the service to continue smoothly throughout the pandemic.
The staff and patient view on using community gyms
At River Bourne the team now has access to a wellness area with 4 private clinic rooms, a separate waiting area and new office, which are contracted out to the NHS long-term. The space provides a safe area for consultations. Feedback from pelvic health patients is that they feel more comfortable in this setting for more intimate examinations. It feels like a private setting too which both staff and patients appreciate. Staff prefer to be somewhere that feels more active with access to better and more advanced equipment, particularly for patients with higher level needs. Overall it is a much nicer area to be based and parking is also not an issue both for patients and staff.
When the idea was first floated amongst the staff to use the gym setting there was a little reticence and concern about change. Concerns about accessing the staff room for breaks etc were one of the issues flagged up. So they ensured there was a good staff induction process. An afternoon was blocked off for the team to visit the gym and the staff so that they could see the space and the equipment and by the end of the session all concerns had been overcome by the recognition that it was an ideal setting to work in. They also had the benefit of additional CPD at the gym site with strength and conditioning training using the advanced equipment on offer so they could see the professional benefits too.
Take-up at other local gyms – the snowball effect
Two further gyms became part of the service offer as a result of the success at River Bourne. One in Egham and one in Woking. The space at Egham was secured in just one meeting. The Woking space came about following a presentation some members of the team did at a Hospital board meeting with Surrey Heartlands CCG. Councillors from Woking Borough Council present at the meeting were so impressed with the initiative that they invited the CCG to consider the community gym, Woking Leisure Centre, as a potential further site for treatment. The first tour of Woking Leisure Centre took place in August and the gym staff were able to offer ideal spaces for treatment and exercise classes, including a board room that could be used as a staff break-out area. Woking Leisure Centre also had a soft play area and studio space that could be used for the paediatric team for their younger patients and gym floor space to accommodate 12 year olds, older children and young adults. Hydropool services were also offered at both River Bourne and Woking with the potential to offer at Egham too. Patient feedback of the hydrotherapy at the community gyms has been positive even though the pool temperature is slightly less than a purpose-built hydro pool. Patients were also more likely to continue using the pool for exercise following their 4 hydro treatment sessions.
Areas to consider in acute versus community gym setting
There are some challenges, particularly logistical, when migrating from an acute to community setting. The initial movement of staff and managing the rota etc can be challenging such as staffing wards and factoring in consultant clinics. The value of the ‘corridor chat’ is beneficial – although this isn’t missed at present while everyone is on MS Teams working virtually but it is something that needs to be taken into account as a valuable part of Hospital site communications. Due to the nature of the paediatric caseload, additional time to supervise staff was needed having lost the corridor chat and informal senior reviews of complex patients after moving away from a 100% face to face model. There were also some logistical challenges to sort such as getting patient transport to these sites arranged. Careful diary planning and organisation has allowed the paediatric and pelvic health teams to still provide their ward service by balancing the needs of the services with virtual and face to face appointments. The River Bourne site is situated only five minutes from the main St Peters Hospital site where the maternity unit is based. Both of these teams also moved a new satellite clinic out to the second main hospital Ashford, where much outpatient activity has now been relocated to support consultant teams and retain close links. The teams have worked hard to ensure that diaries are planned in such a way that team members still have plenty of time to work alongside each other, without being spread too thinly across sites for the smaller team.
Influencing the local MP and the NHS Parliamentary Award
In the summer of 2020, the team decided to showcase their approach to maintaining patient rehabilitation during the pandemic using the community gym settings. They were aware of the NHS Parliamentary Awards, which is a process where an NHS team invites their local MP to nominate their service for an award. So the team contacted local MP Dr Ben Spencer to witness the fantastic work they were doing with patients at River Bourne. Dr Spencer was very happy to be approached and suggested spending half a day at the gym where he enjoyed a presentation with the team, a tour and took part in one of the virtual classes. As a result Dr Spencer nominated the team for the ‘Future NHS Award’ which they won for the South East region and have been shortlisted for the national awards taking place in July 2021.
Looking to the future
As the pandemic continues with virtual delivery of treatment and classes, the team are looking at recording exercise films to share with their patients as part of their service. They have just secured £1300 from Sport England to produce videos to help older people who may be deconditioning as a result of lockdown. They have set-up a You Tube channel which they hope to develop as the videos are produced. The Pelvic Health Team are also looking at securing funding from the Trust to develop videos for their patients. The building of the new purpose built site at Woking Leisure Centre, including 5 brand new clinic rooms, has now been completed. The teams are due to start working clinically from there in March 2021. Patients are enthusiastic about the possibility of accessing sites nearer to their own homes. The development of new sites has also allowed all teams to review the services they are providing. This allows a blank canvas and opportunity to create new classes and clinic set-ups to aid the rehabilitation of these patient groups and provide top class services within modern facilities.
Inspiration for considering this approach in your area
The ASPH example was a massive team effort across all 3 outpatient physio departments. The achievements show what is possible if a team is involved in the decision-making process and take leadership roles to see an initiative come to life and then everyone has a share, stake and passion for making the initiative a success.
If you are considering using community gyms, now is the perfect time while they are closed because of Government guidelines as they have the scope to re-organise space and revise timetables. They are also particularly receptive because of the impact the pandemic has had on gym footfall since Covid struck. So the team’s advice is don’t wait – approach them now. Here are some tips to get you started:
- Get your entire teams involved in the decision making process from the beginning – this allows for great ideas to be generated and the team to take ownership of the service change undertaking.
- Arrange to meet key stake holders like your hospital executive team and CCGs. Getting them on board with an idea helps the speed and success of a relocation project.
- Think inventively for solutions to challenges that arise and be ready to be flexible and adaptable – good communication to teams and working together can help overcome any obstacles successfully
- Support your team in embracing change. The world of NHS physio is changing and moving toward enabling patients to become active participants, which is best served in a non-hospital setting. By increasing outpatient team knowledge and confidence of current evidence-based practice and strength and conditioning principles, staff will feel comfortable working in new surroundings and achieve more satisfaction in their working life.
https://www.youtube.com/watch?v=vEdGdf9giBw – The team’s presentation to the Board that helped gain more interest which lead to opening doors for Woking Leisure (starts at 5mins till 40 mins)
River Bourne website (the team’s first venture into commercial gyms) https://www.theriverbourneclub.co.uk/
Woking Leisure will the team’s third gym to start working from https://www.freedom-leisure.co.uk/centres/woking-leisure-centre/
The ASPH Physiotherapy You Tube channel - https://www.youtube.com/channel/UC3Kntpcobf92RW7g4-iimFw
The NHS Parliamentary Awards - https://www.england.nhs.uk/nhs-parliamentary-awards/
How to find your local MP - https://members.parliament.uk/FindYourMP
If you are interested in putting forward your service for an NHS Parliamentary Award for 2021, please contact The CSP’s Campaigns and Regional Engagement Team firstname.lastname@example.org
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