Greater use of self-referral, an allied health professional-led delivery model, and improved data, are set to be brought together to overhaul rehabilitation for patients with musculoskeletal problems in Scotland.
The proposals, developed as part of the Scottish Government’s Delivery Framework for Adult Rehabilitation, would put physiotherapists and other AHPs at the forefront of musculoskeletal rehabilitation in Scotland, with roll-out of the model beginning as early as next year. They also suggest centralising the system of self-referral for physiotherapy using NHS 24, the Scottish online and telephone information and self-care advice service. Patients would be triaged through the NHS24 telephone service, and either given advice on self-management, electronic referral to a local MSK clinic, or an alternative method of self-referral via walk-in to local departments. All appropriate interventions would be delivered or sign-posted by an AHP team, including either discharge or referral to rehabilitation teams, self-management teams, leisure facilities, or secondary care. The new model of care is designed to improve access to diagnosis and treatment, cut waiting times, develop a self-management culture among patients, speed up return to work and support the shift from hospital to community care outlined in the Scottish Shifting the Balance of Care proposals. One of the key factors in ensuring the model develops successfully is detailed data on musculoskeletal rehabilitation of patients across Scotland. Information on the treatment of patients with low back pain, shoulder, hip, knee, foot, and ankle problems is being mapped in a country-wide study of community musculoskeletal rehabilitation and expert panels will draw up recommendations for practice and patient pathways following a major conference to be held in May next year. Sarah Mitchell, programme manager for the Delivery Framework for Adult Rehabilitation, said the NHS Lothian health board was already piloting managing self-referral for physiotherapy through NHS24, and that the wider model of musculoskeletal rehabilitation would be piloted in two health board areas, NHS Lothian, and NHS Lanarkshire, from early next year. ‘The aim is to have a national musculoskeletal service with physios as gatekeepers who will ensure that targets are met, but most importantly that patients have the best journey of care possible,’ she said. Kenryck Lloyd-Jones, CSP policy officer for Scotland, said: ‘The CSP fully supported the rehabilitation framework, and the advances in self-referral, patient data and the shift to primary care make for exciting developments in musculoskeletal services in Scotland.’
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