The purpose of this project was to demonstrate the positive impact an Independent Prescriber Physiotherapist could have on the service delivery in outpatient spasticity clinics. The project aimed to demonstrate reduced patient waiting times for review appointments, reduced cost per appointment and demonstrate high patient satisfaction. The overdue waiting period for spasticity reviews is a long standing problem for the spasticity service and on the Trust risk register. Historically spasticity clinics were managed in multidisciplinary team (MDT) clinics involving a Consultant and a Physiotherapist. A proposal was put forward to the team and agreed. This proposal was for a single Physiotherapist Independent Prescriber, with experience in management of spasticity and neuropathic pain, to set-up a pilot period of Independent Physiotherapy led spasticity review clinics.
Patients who were already overdue their spasticity review appointment by 31st December 2018 were identified from the waiting list and filtered according to the following criteria;
Inclusion: Patients who have previously had an initial assessment in the Spasticity clinic. Exclusion: Patients who would be best managed in an MDT environment due to very high level of complexity where the opinion of more than one professional would be of benefit. Patients who required injection with Botulinum Toxin within the review appointment (as the named clinician was not qualified in injecting).
This was a time limited pilot as the clinician was due to rotate to another clinical area. The project was carried out in addition to the clinician’s existing workload therefore a sample size of the 10 patients were identified to fit the clinician’s capacity. The 10 patients taken were the most delayed following inclusion/exclusion filtering.
All patients were given a satisfaction questionnaire where the following questions were yes/no and had opportunity to add further comments: 1. Do you understand why you were seeing the Physiotherapist? 2. Do you feel that you were treated with dignity and respect? 3. Did you feel able to explain what you wanted and to ask questions? 4. Did you feel that your point of view was respected and taken into account during your appointment? 5. Did you feel confident in the knowledge and skills of the Physiotherapist? 6. Do you understand any medication changes following this appointment? 8. Do you have any thoughts on what we could do to improve your experience with the Physiotherapist Independent Prescriber? The following question was rated on a 6 part scale of excellent to very poor: Overall, how would you rate the service you have received today? The following question was rated on a 6 part scale of extremely likely to extremely unlikely: Based on your experience how likely would you be to recommend us to friends and family should they need similar care or treatment?
Data was collected on additional time (from December 2018) that patients had to wait for the Independent Physiotherapy Led Spasticity review and the estimated wait for the joint Consultant/ Physiotherapist review.
The Independent Physiotherapy led spasticity reviews reduced further waiting times (from 31st December 2018) by 1-3 months for each patient, with a mean average 1.8 months.
9 out of 10 patient satisfaction questionnaires were returned. 100% of questionnaires rated the service excellent/ very good, 100% were extremely likely/ likely to recommend the service to friends or family and there were 100% positive answers on all other questions on the questionnaire. All comments in free text were positive.
Cost and savings
Within the spasticity service a mid-point salary for a Consultant cost £59.13 per hour and a mid-point Band 7 Physiotherapist per hour cost £29.41. Joint Consultant/ Physiotherapist review clinics were 30 minutes, costing £44.27. Independent Physiotherapy led review clinics were 60 minutes costing £29.41. There was a cost saving of £14.86 for each appointment.
A Physiotherapist Independent Prescriber with expertise in spasticity management and neuropathic pain management can successfully carry out spasticity clinic reviews independently with high patient satisfaction. It can be concluded that the spasticity waiting list could be reduced further with the setup of regular Independent Physiotherapy led spasticity clinics. Consultant time would be more available for very complex patients or for treating patients who require interventions such Botulinum Toxin or nerve blocks as part of their treatment. Despite the Independent Physiotherapy led clinics being an hour in duration in comparison to a 30 minute MDT appointment, there was still a significant cost saving per appointment, which when multiplied could have a large cost saving for the service.
A longer period of analysis would establish if this role would be cost effective. As a result of this work, a business plan has been agreed to recruit a full time Independent Prescriber Physiotherapist for 12 months to enable regular Independent Physiotherapy led spasticity review clinics to be carried out as part of the role.
Top three learning points
Physiotherapists can utilise their specialist skills and knowledge to help shape Physiotherapy job roles.
Physiotherapists need to be forthcoming with their innovative ideas.
Physiotherapists need to highlight the success of their service innovations to management in order for change to be considered.
This work was unfunded.
For further information about this work, contact Jennifer Curran.