Reconfigured physio services in Cambridgeshire could prove a model for better patient care. Gary Henson reports
A patient-centred redesign of MSK services in Cambridgeshire with increased physiotherapy staff has been held up as ‘an excellent model of care’ by the CSP. The revamped service, reported in Frontline, 5 May (‘Boost for physiotherapy’), aims to treat patients more quickly and conveniently, with increased care in the community and better access to physiotherapy through self referral. With significant numbers of patients being seen unnecessarily in secondary care, the trust identified the cost of these referrals, decommissioned the secondary care activity and reinvested in community physio services. Two band 8a extended scope physiotherapists and five band 6 physios have been recruited this year, with two new admin posts to be filled. The seven qualified staff join the existing 12 full-time physios and the team will share an acute and community workload. In addition, hospital-based extended scope physios and a consultant rheumatologist will hold clinics in the community. Jill Gamlin, consultant physio and MSK clinical lead for the trust, described the development of a second tier of multidisciplinary community service as ‘exciting and very satisfying’. A previous attempt at redesigning MSK services had failed, she explained, due to the complexity and difficulty in gaining agreement. ‘What made the difference now is the willingness of organisations and clinicians to find solutions, particularly in view of the need to use resources wisely and the drive by commissioners to improve services for patients,’ Jill Gamlin said. The new service is exciting as it provides an opportunity for all clinicians involved in the patient pathway to work together in the most efficient and effective way. It is satisfying to have worked as a strong team to achieve what appeared at the outset to be an unattainable goal.’
Physio skills boostedFor the patient, the new service would provide the appropriate level of care delivered by the right clinician, Jill Gamlin explained, adding that the new ‘vertically integrated’ way of working aimed to remove unnecessary waits in the pathway. Physiotherapy skills would be enhanced, with supervision and training at every level. Juniors would improve their knowledge by observing second tier community clinics, while seniors would be trained to use PhysioDirect, the telephone-based advice service, which would improve listening, communication and clinical reasoning. Clinical specialists would benefit from sharing knowledge and skills with GPs, including those with special interests, and with trainee doctors and hospital consultants. Consultants would supervise training in injection therapy and supplementary prescribing, with ongoing mentoring.
Patient at centreCSP professional adviser Ruth ten Hove said: ‘They have thought of the needs of the patient and have built the service around that. This model seeks to extend and consolidate the accountability and responsibility of the physiotherapist. It is a complex model of MSK management which is developing the role of the physiotherapist as the first point of contact practitioner, as the expert clinician and clinical manager, and as the provider of a patient-focused service.’ Ruth ten Hove said it gave staff more opportunities for career development ‘because of the recognition of the service for development into senior clinical positions’. ‘The close working relationship which the business manager has with the service means that physios are exposed to much more information about its efficiency. This may give them other opportunities to think about management, commissioning, planning and so on.’ Sarah Saul, MSK physiotherapy business manager for the trust, said delivering a high-quality safe service in the community required the right clinicians with the most appropriate skills to be available within the clinic. Vertical integration had made the expertise of a rheumatology consultant available to patients with more complex medical conditions. ‘Bringing together two teams of specialist physios from secondary care and community services reinforces established relationships and close links with secondary care consultants, which facilitates onward referral of patients when required,’ Sarah Saul said. It was hoped to expand the service to include some hand surgery such as carpal tunnel release, she added, and there was also an opportunity to develop podiatric surgery –– currently carried out elsewhere in the trust –– as part of the service, as well as a multidisciplinary community service for patients with persistent pain. fl
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