The First Contact Physiotherapy Service was established as a pilot within the musculoskeletal service in January 2019. This patient evaluation project was undertaken in order to:
- Ensure the service was meeting the needs of the patients accessing it.
- Capture patient experience.
A bespoke patient experience postal questionnaire was designed and sent to patients who accessed the service between January and June 2019.
- Thinking about your recent appointment with the First Contact Practitioner, how satisfied were you with the service which you received
- What would you have done if you were unable to see a Physiotherapist today?
- Are you happy with the time it has taken to be seen?
- Following your recent appointment, do you feel that you need to book a GP appointment for the same problem?
- How likely are you to recommend the First Contact Practitioner to friends and family should they need similar care or treatment?
- Thinking about your recent appointment is there anything that you felt we did particularly well or any areas where we could improve?”
The questions chosen aimed to identify patient satisfaction; potential reductions in GP appointments, A+E or walk in centre attendance; waiting times; preventing recurrent GP appointments for the same problem; confidence in the therapist and gave patients the opportunity to suggest improvements which could only help to improve the service.
Questions 1 and 5 were taken from our friends and family questionnaire. All other questions were selected in line with the objectives of the pilot.
An excel spread sheet was also completed recording Pt diagnosis and management for all patients (e.g. self-management, physio referral, imaging, prescriptions). The outcomes are presented in the table below.
A total of 660 patients were sent the questionnaire and 219 were returned complete, a completion rate of 34%. The findings are as follows:
Overall satisfaction: 96% of patients were either satisfied (n=33) or very satisfied (n=177) with their recent appointment with an FCP.
Alternative Care: Patients who attended an FCP would have accessed other healthcare professionals had the service not been available. This includes 60% (n=130) who indicated they would have sought an appointment with a GP and 6% (n=14) who would have accessed a walk-in centre. Two patients would also have attended A&E. 24% (n=50) of respondents would have sought alternative treatment, including self-referral into core physiotherapy services or private physiotherapy.
Wait times for FCP appointment: 99% (n=215) patients were happy with the time they waited for an appointment with an FCP. Free text entries illustrate a number of patients were seen on the same day they requested to be seen.
Self-reported need for GP follow up: 70% (n=153) indicated they did not feel they needed a GP appointment for the same problem once they had seen the FCP. 11% (n=24) felt they did need an appointment with the GP to discuss the same problem.16% (n=34) were unsure if they would need to see the GP following their consultation with the FCP
Friends and Family results: 96% of respondents were either extremely likely (n=167) or likely (n=39) to recommend the FCP service to friends or family should they need similar care or treatment.
Positive feedback: Respondents were able to enter free text to comment on areas of strength or improvement. The overwhelming majority of comments were positive. Many comments praised the short wait to see the FCP in comparison to a GP, the location within the practice, the attitude, skills and knowledge of the physiotherapist.
Examples of such comments include:
- "Much better than a three week wait to see a GP who may not be able to diagnose and treat like a physiotherapist can."
- "Saved waiting weeks for a doctor's appointment to then be referred. Very impressed, thank you!"
- “I was so pleased thank you. I was absolutely delighted with this service and one appointment was all that I needed”
- “I was accurately assessed with the correct exercises given to improve my back pain which has helped dramatically. Excellent service.”
There was evidence of some patients understanding the role of FCP and the impact of social prescribing:
- “Anyone with back or muscle pain should see a first contact practitioner service. GP will have more time to see other patients”
- “The consultation resulted in ….a referral to a sport centre which has led to my weekly attendance there”
Areas for improvement: A number of free text comments suggested they had already seen the GP prior to the appointment with the FCP. There were a number of requests for follow up appointments illustrating some issues with clarity of role for some patients:
Examples of such comments include:
- “Excellent service, although I would have liked a follow-up appointment”
- “Perhaps a follow up appointment to check progress”
- “Helpful but need to be clear as to what kind of service this is”
- “Actual hands on physiotherapist would have been good instead of an assessment and a sheet of exercises to do”
As a result of this we have advised all patients that they can return if they feel they are not improving Patient management.
Data taken separate to the patient experience study from January to August. Management of all contacts was recorded using an excel spreadsheet.
1116 contacts Jan- August 2019:
- 79 % Self managed
- 2.9% Podiatry
- 2.2% Pmsk
- 6.3% Physio referral
- 3% Investigations
- 1% Bloods
- 5.2% Prescriptions
- 0.26% ENT
- 1.3% Escape pain
Onward referrals from the GP clinic into physiotherapy department reduced. When comparing number of referrals from the practice before and after the implementation of FCP.
Cost and savings
No cost (other than administration costs for printing and postage) was associated with this project. Data analysis was completed by service lead.
Work on second contact, promote service as a first contact service = really educate practice staff on purpose of role , promote role with patients/patient education (understandable there are some issues given new initiative – awareness should grow, especially if GPs and other practice staff are clear on role)
Need to maintain short/zero waiting times - key area of strength.
Patients are advised to come back if they have not improved this will prevent rebooking an unnecessary appointment with a GP. First contact physiotherapy has been highlighted on the practice website as well as a link for them to request an appointment; the patient sends an email and is then called by reception for screening. As many patients book online this will hopefully reduce the number of patients seeing their GP prior to seeing the FCP
GP’s have received in-service training from the FCP regarding management of rotator cuff tendinopathies. Training such as this has the potential to improve GP’s management and potentially lead to more appropriate onward referral and reduction of unnecessary imaging.
We hope to now promote this service to reach a wider population of Oldham and hopefully this data can be used to show it potential benefits to other practices.
Top three learning points
- Informing patients about the service is key to its success; this has been made difficult due to the fact that many patients do not visit their GP regularly and are therefore unaware of changes to the service. Due to data protection we were unable to send information directly to these patients. We have tried using the posters and also the practice website but still seem to be missing a lot of patients who end up seeing their GP first. We have now added a note to the online booking system informing patients of the service. More recently the practice has set up a triage service where a patient who is unable to receive an appointment on the day will be called by the Nurse or GP and managed appropriately, this has increased referrals to FCP.
- Integration of the physiotherapist into the practice with faced to face contact has been very useful. As I work in 1 practice full time I have developed a good working relationship with all staff and regularly have GPs seeking my opinion. Reception staff are happy to speak to me if they are unsure regarding suitability of staff to booked with me. I feel this would be more difficult if I were only working 1 or 2 sessions weekly.
- The level of experience of the professional is vital for safety and success of patient management. As the first line of contact there is an increased likelihood of seeing more serious pathologies, for this reason I feel that this role should require specialist training. Access to support of GPs when necessary and also advice from tier II services is necessary for peer support and learning and development. Access to imaging would also be beneficial as I have found my patient care has been delayed by me having to refer to another organisation. Non- medical prescribing has also been very useful.
Funding for this project came from transformational funds.
For further information about this work please contact Simion Mattis.