Lessons Learned from Implementing a First Contact Physiotherapy Service via a Single and Dual hub model. A Narrative

Purpose

GP cluster funding of first contact physiotherapy(FCP) and the complexity of the planning of FCP into individual GP practices necessitated the need to change standard provision of care utilising a single and dual hub model in two separate GP cluster areas in North East Wales. The aim of this study was to evaluate the impact of using a single or dual hub design for providing FCP care.

549 patients were referred into physiotherapy rehab
representing 10.1% of all patients seen
There were 74 orthopaedic referrals
a monthly average of 3 patients, representing 1.4% of all patients seen.

Approach

Comparison of key performance indicator outcomes collected from first contact practices within single GP surgeries and hub model provision.

Outcomes

Results: The North Wrexham single hub model staffed by 1 WTE B7 over a 5 day working week served a population of ~40,000 patients across 6 GP practices, providing FCP care for 28 months, [September 2016-December 2018] with a total of 5432 patients seen averaging 194 per month, with the 1st point of contact rate averaging 57%. 549 patients were referred into physiotherapy rehab with average referrals of 19 per month representing 10.1% of all patients seen. There were 74 orthopaedic referrals within this time period, monthly average of 3 patients, representing 1.4% of all patients seen. PREMS reported ease of parking but also PREMS pt's preference of hub model wholly dependent if hub close to pt's own surgery and parking easier than own GP practice.The North West Flintshire dual hub model ran by 1 WTE B7 physiotherapy practitioner served ~ 50,000 patients across 7 GP practices utilising 2 locality hubs. The service ran from March 2018 to October 2019 seeing 3316 patients, averaging 165 patients per month. Referrals to physiotherapy rehab and orthopaedic rehab were 328 and 16 respectively with monthly averages of 16 and 1, representing 9.9% and 0.5% of all patients seen.

Conclusion(s): No difference in KPI's (key performance indicators) between hub and single GP practices were evident. There appears to be marked differences in average 1st point of contact rates within hub services comparisons, which may be attributable to the physiotherapist using a different 1st POC definition or the GP practices did not sufficiently understanding the service despite education input. The logistics and success of the hub model depends upon the motivation and assistance from the GP clusters; clear planning is imperative. Difficulties with IT provision between secondary and primary care IT systems necessitated novel IT solutions. Provision of hub model FCP can be of benefit allowing increased GP practice participation, facilitating more equitable provision of FCP, allowing smaller/single handed GP practices access to FCP. Specific and carefully tested pathways are needed to allow correct patient navigation. Locating suitable areas for hubs to be installed within health board assets may be a limiting factor. A clear pathway of referral mechanism to allow patient self referral and GP referral needs to be implemented. Specific and agreed methods of communication between GP practice principals are needed to allow for provision of fit notes/medical referral/complex patient discussion.

Cost and savings

No further information. 

Implications

This is a novel way of providing FCP care, which can be incorporated into further FCP considerations and planning.

Top three learning points

No further information. 

Funding acknowledgements

This work was not funded.