By Treating Farsi-speaking patients in groups Jeelna Ruparelia boosted attendance rates, Gill Hitchcock finds
For the past 12 months musculoskeletal (MSK) physiotherapist Jeelna Ruparelia has combined her clinical role at Central London Community Healthcare Trust with work on a project to shake-up MSK services in Barnet and Westminster.
As Barnet’s physiotherapy transformation lead on the ongoing project, she is helping shape proposals for how the two north London boroughs can collaborate to achieve more cost effective and higher quality care.
‘We are thinking about the skill mix needed to meet the demands of the service effectively, introducing flexible working and extended hours for better patient access; and using patient-reported experience measures and patient stories as a key driver to change,’ she says.
Ms Ruparelia has been with the trust as a band 6 MSK physiotherapist for two years. After graduating from Brunel University as a physio in 2009, she worked at Whipps Cross University Hospital in east London for two years.
But her experience helping to initiate group physiotherapy classes with a translation service for Farsi-speaking patients at Edgware Community Hospital should be particularly valuable for a future item on the project team’s agenda – the effective delivery of group therapy.
Since 2012 the hospital’s group therapy sessions have provided exercise and self-management techniques for Farsi-speaking service users with long-term pain.
She says that the group’s work with up to 10 patients, plus one physio and an interpreter, have cut costs by 58 per cent, compared to conventional oe-to-one treatment and an interpreter.
‘A physiotherapy assessment costs the NHS about £49 per patient and £35 per follow up. Interpreters typically charge £35 an hour. So a missed appointment with an interpreter booked wastes approximately £84 per individual session,’ she reveals.
In addition ‘did not attend’ rates have fallen since the sessions were introduced. Ms Ruparelia explains: ‘With one to one sessions, patient understanding of physiotherapy was not there.
‘Patients felt like they did not have much time. They might come for their assessment and not come afterwards. In the class there is much more education, and they actually enjoy the exercise element within a gym, which is part of the two-hour class.’
Farsi speakers, many of whom hail from Iran and Afghanistan, make up about 40 per cent of the demand for interpreter services at Edgware’s MSK physiotherapy department. The groups are part of the trust’s Promoting Access to Health programme, intended to encourage innovative practices with a cash reward to be spent on service development.
Asked about the most challenging aspects of delivering the classes, Ms Ruparelia’s response is swift: ‘paperwork’. She explains that class ‘outcome’ forms are all in English so the translator has to read the questionnaire to the patients at the start and end of each block of sessions and then helps them complete the forms. Preparation of a Farsi version of the forms is under way, however.
The most rewarding aspect of delivering the service is the high level of patient satisfaction and getting people back to work. One patient who had been out of work for many years, for example, was able to start a job after completing the block of six classes.
‘We have had great feedback from patients,’ she says. ‘They felt they were given more time to express their pain, and enjoyed the education topics on chronic pain to gain a better understanding of their condition. They said they found the supported environment for exercise useful to build on confidence, and the relaxation techniques helped to bring a sense of wellbeing.’
Ms Ruparelia’s advice for those considering setting up a similar service is that classes will always be more cost effective, but says that the referral criteria need to be clear.
‘And you need clear outcome measures and interpreters who have the skills to engage in and be part of the service, rather than just being a voice.’ fl
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