Data analysis on the role of the Independent Prescriber in Physiotherapy led spasticity clinics

Purpose

Overdue outpatient spasticity reviews was a long standing problem for the Spasticity Service and on the Trust risk register. Historically, spasticity clinics were multidisciplinary (MDT) involving a Consultant and a Physiotherapist. The purpose of this project was to demonstrate the positive impact a Physiotherapist Independent Prescriber (IP), highly experienced in spasticity management, could have on the service delivery in the Spasticity service. The project aimed to demonstrate reduced patient waiting times for review appointments, reduced cost per appointment and demonstrate high patient satisfaction.

Mean average 1.8 months
for an IP led spasticity review
1-3 months
reduction in waiting times for spasticity review through use of IP

Approach

Overdue spasticity review appointments (from 31st December 2018) were identified and filtered according to criteria. Inclusion: Patients who had 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 (named clinician 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.

All patients were given a satisfaction questionnaire with questions related to their experience of the service that they received.

Data was collected on additional waiting time (from December 2018) to the IP led Spasticity review and the estimated wait for the joint Consultant/ Physiotherapist review.

Outcomes

Results: The IP led spasticity reviews reduced further waiting times by 1-3 months for each patient, mean average 1.8 months. 9 satisfaction questionnaires were returned. 100% 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. All comments in free text were positive. 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.

Conclusion(s): A Physiotherapist IP with expertise in spasticity 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. Despite the Independent Physiotherapy led clinics being an hour in duration in comparison to a 30 minute MDT appointment, there was still significant cost saving per appointment, which when multiplied could have a large cost saving for the service.

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.

Implications

As a result of this work, a full time IP Physiotherapist was recruited from March 2020 to enable regular Independent Physiotherapy led spasticity review clinics to be carried out as part of the role.

Top three learning points

No further information. 

Funding acknowledgements

No funding