Exploring the role of an advanced physiotherapy practitioner as an independent non-medical prescriber within a secondary care chronic pain service

Purpose

Chronic pain services within Glasgow have traditionally run on the model of individuals being assessed by a medical consultant at first contact. With growing demands on the pain service and the drive towards new models of care, advanced physiotherapy practitioners (APP) are well placed to step up to support and meet this demand. The recent advancement of physiotherapists as non-medical independent prescribers (NMP) has offered further scope for benefitting patient care and flow within the service. An initial one year pilot study was undertaken whereby at initial referral, appropriate patients were triaged to physiotherapy as the first point of contact. The aims were:

1. To gain a more accurate understanding of the patient demographics seen within the first contact chronic pain clinic for APP’s.

2. To explore the extent to which the independent non-medical prescribing (NMP) qualification is used within the first contact clinic.

Within 68% of APP consultations
a discussion about medicines took place that required a NMP qualification.

Approach

Following the commencement of the APP role within the chronic pain service an audit of demographic data and outcomes was undertaken. Outcome data collected included the appropriateness of seeing an APP at first contact, whether the use of NMP was required and the pathway in which the individual was referred onto. Data was collected over the 12 month period of the initial pilot.

Outcomes

Results: Data for 115 individuals who attended an APP was collated (M=20, F=95). 103 were deemed appropriate to be seen by an APP, with 12 were not. 51% reported pain in multiple sites, 15% had lower limb pain, 12% had low back pain with radicular symptoms and 11% had low back pain only. All patients seen had a MSK component to their pain. The most common expectation individuals had of seeing an APP at first contact was to discuss self-management options, with expectations of pain reduction and medication advice being the next most common. Within 78 of the consultations (68%), a discussion about medicines took place that required a NMP qualification. These discussions included prescribing, de-prescribing, titrating and general advice or information. As a result, concerns about medication could be addressed rather than having to wait for a further review appointment in another clinic.

Conclusion(s): The APP role has become now well established within the chronic pain service and has aided in improving both quality measures and expanding capacity. The audit demonstrated there was a sufficient capacity for individuals appropriate to see an APP, with further clinics to expand the APP role being planned.

Cost and savings

No further data available. 

Implications

Debate has remained within the service regarding whether NMP should be a pre-requisite for the role, however, this audit highlights the benefit to the patient journey of being seen by an APP with the NMP qualification. Further work is required to have a more detailed understanding of the types of medication consultation that take place and also to understand how the APP can be further expanded, to further promote the positive role of physiotherapy within the chronic pain setting.

Top three learning points

No further data. 

Funding acknowledgements

None