Stronger my way: how a service understood and adapted to local need

Stronger My Way equips healthcare professionals with the skills and knowledge to enable patient behaviour change. Key components of this are understanding local needs and the delivery of cultural competent services. Here we speak to Connect Health about the steps they take to map their area, engage with their communities and adapt services to meet their patients’ needs.

Mapping local need

Darren Finnegan, Physiotherapy Team Lead for Connect Health works within the South Tyneside community-based musculoskeletal service.

He explains: ‘In South Tyneside we looked at the wider health ecosystem and challenges facing healthcare professionals with engagement in Making Every Contact Count conversations.’

Fuelled by completing the All our Health course, Darren researched South Tyneside’s local demographics using Public Health England data realising the catchment had the lowest physical activity in the North East.

South Tyneside had 57.2 per cent, compared with the Northeast average at 64.7 per cent. England-wide, 66.4 per cent of adults achieve less than 30mins physical activity per week.

The South Tyneside MSK team concluded that physical activity was a significant part of the solution to tackling local health demographic challenges. Physical inactivity along with a historically high opioid and medical imaging rate in South Tyneside made them reconsider the delivery of the community MSK service.

‘There is a rising tide of chronic MSK conditions and associated mental health problems, not to even mention the impact of social determinants of health. We became more proactive and future focused to address the root causes of obesity, health literacy and low physical activity levels.’

Public Health mapping ensued and involved creating patient information leaflets for modifiable lifestyle factors such as smoking & alcohol cessation, physical activity options and local community support groups. This enabled behaviour changes initiatives, with soft touch signposting before the team developed better links with ESCAPE Pain, First Contact Clinical and Versus Arthritis.

‘The main team wins came from System 1 MECC integration and Make Every Contact Count (MECC) staff training. This meant we were capturing, measuring, and managing all the MECC conversations. We shared our plans with other services and had meaningful collaboration.’

Connect Health Services measured 228,000 MECC national conversations from September 2020 to 2021. South Tyneside MSK services, had 28,000 conversations in the same period. It is now at 44,000 conversations which equates to almost 1 in 3 people in the whole South Tyneside region.

Darren advises that ‘AHPs must be future focused by putting population needs first. This starts with identifying future challenges in MSK such as we are living longer, less active, and more overweight as a society. We wanted to adopt a whole life approach, while refining the delivery of MECC staff training.’

‘It’s pivotal for our team to feel capable and competent to deliver effective conversations, about modifiable lifestyle choices - like nutrition, giving up smoking, lessening their alcohol intake, while giving them tips on weight loss and physical activity exposure. For far too long, we presumed all physios are confident in these conversations. ‘

Darren recently spoke at the Physio UK 2021 conference and had his abstract published on MECC Implementation in MSK practice. This is on the back of a podcast, Chewing it Over with Jack Chew- ‘Public Health Interventions in MSK’ with his fellow South Tyneside Team Leader, Rebecca Gray. Link Here

The South Tyneside MSK teams vision was supported from the outset by the Clinical Commissioning Groups (CCGs) for which it is grateful. They launched a service redesign called #Rehab Re:Imagined and considered where rehabilitation is best suited. Council run leisure centres were the ideal location which is where they now run group and 1:1 rehab sessions. Hal Brace, Service Manager, and Tim Raffle, Team Leader, were instrumental in ring fencing time for #Rehab Re:Imagined.

Darren concludes ‘We launched ‘Fit 4 Life’ group sessions to help patients post-COVID engage in social interaction again. We introduced socially distanced group exercise sessions for active aging focusing on a whole-life approach. This involved exercise, education and proved beneficial for those who were socially isolated and deconditioned over the COVID pandemic. ‘

South Tyneside MSK Clinical Lead, Nick Livadas, reports, ‘Pulling on the research from Mary O’Keefe et al, I’m increasingly confident we made the right call with our non-disease model vs the traditional knee/hip/spine class. Our population is ageing and the demand on our service is increasing. Let us keep ahead of the curve and ensure we continually improve our rehab offer to ensure we are not just fit for life but fit for the future’

Engaging communities

When team lead Rebecca Gray joined Connect South Tyneside MSK team last year, she noticed Black, Asian and Minority Ethnic communities were marginalised within the local health and social care system.  

As a first step, Rebecca attended a group session at local charity, Aphna Ghar, and discussed physical activity, health education, and active aging.

‘It shocked us that some ladies had arthritis for 20 or more years and never accessed physiotherapy, because of language barriers,’ she said.

Rebecca explained they created drop-in sessions for local residents from minority ethnic communities.

‘We held sessions for knee and hip arthritis, which the attendees enjoyed,’ she said.

‘We talked about appointment availability, with physiotherapists and GPs, and what makes a good or bad appointment.

‘We learnt about patient preferences for care delivery and whether face-to-face or virtual was better, and when. 

‘We asked if female patients were open to group exercise and discussed their information delivery preferences, like paper leaflets for exercises in their own language, or emails and videos.’

Rebecca’s team learned a great deal from patient engagement.

She continued: ‘They wanted women-only classes and we looked at creating ladies-only physiotherapy.

‘We collaborated with local charity WHIST, who had women’s only classes. We looked at accessible material delivery with language translation.

‘We approached GPs to promote our service, and be more culturally aware of linguistically diverse populations.

‘We held discussions with patients and gave contact details for self-referral, as many ladies had joint pain, and hadn't accessed health care because of the language barriers.

‘As a community, we need to work towards better accessibility, inclusion and promotion.’

Adapting your service

Rory Twogood is the Team Lead Physiotherapist at Camden Health Connect.

‘In Camden, we run therapist-led classes in groups of up to 10 patients, run by an MSK clinician and rehab therapist and one class a week is for women only,’ he said.

‘Patient feedback suggested significant numbers of female patients did not want to come to mixed gender classes, so by doing this session – led by female therapists – we have opened up access and provided a route into physical activity.

‘Sessions last for 45 minutes with 20 minutes of therapist-led, whole body strengthening exercises.

‘This is followed by 20 minutes for patients to do their specific rehabilitation exercises, with support and guidance.

‘We give support to patients who are less confident with strength training and need more guidance with technique.’

The setting of the sessions is also important, Rory explained.

‘All classes are held in the Better Leisure Gym in Kentish Town. The aim is to move healthcare out of hospital and clinics, into healthy community spaces. 

‘Patients attend up to six exercise classes or gym floor rehab sessions. The goal is for them to be confident to continue to exercise as they wish, at home, their own gym, or community exercise classes.’

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