The NHS Long Term Plan, published on 7 January, is a major breakthrough for physiotherapy in England, says the CSP.
Across a range of conditions, and in a range of settings, physiotherapy and rehabilitation are highlighted.
Specific commitments include
- increasing the number of physios in primary care
- rolling out first contact physios
- improving access to rehabilitation in a wide range of areas including frailty, stroke, pulmonary and cardiac conditions
What the plan says for the physiotherapy profession:
First contact practitioners
We will build on work already undertaken to ensure patients will have direct access to MSK First Contact Practitioners (FCP). 98% of STPs have confirmed pilot sites for FCP and 55% of pilots are already underway. We will expand the number of physiotherapists working in primary care networks, enabling people to see the right professional first time, without needing a GP referral.
The workforce implementation plan will continue recent provision for a range of other roles – including pharmacists, counsellors, physiotherapists, nurse practitioners – building on the success in expanding these numbers by nearly 5,000 over the past three years – and hence building the skill mix to relieve pressure on GPs... Initially, this will focus on clinical pharmacists, link workers, first contact physiotherapists and physician associates.
Improving access to online support for MSK issues
We will also expand access to support such as the online version of ESCAPE-pain (Enabling Self-management and Coping with Arthritic Pain through Exercise), a digital version of the well-established, face-to-face group programme.
The £4.5 billion of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices that work together.
The result will be the creation – for the first time since the NHS was set up in 1948 – of fully integrated community-based health care. This will be supported through the ongoing training and development of multidisciplinary teams in primary and community hubs.
By expanding pulmonary rehabilitation services over 10 years, 500,000 exacerbations can be prevented and 80,000 admissions avoided. To increase access to pulmonary rehabilitation, a population-management approach will be used in primary care to find eligible patients from existing COPD registers who have not previously been referred to rehabilitation.
Scaling up and improving marketing of cardiac rehabilitation to be amongst the best in Europe will prevent up to 23,000 premature deaths and 50,000 acute admissions over 10 years.
The long-term plan signalled a new approach to rehab, organised around symptoms and patient needs, rather than condition, by taking on board the potential for combined cardiac and respiratory rehab programmes. This was a point that the CSP has highlighted in its submission to the plan.
The plan said:
Breathlessness is a very common symptom that is shared by a number of cardiac and lung conditions as well as psychological and mental health conditions, and is compounded by physical de-conditioning. Generic pulmonary and cardiac rehabilitation programmes have been shown to be effective for both conditions, providing an opportunity for cardiac and pulmonary rehabilitation groups to join forces and manage the groups collaboratively. Test and learn demonstrators will be used to establish an evidence base for joint cardiac and pulmonary rehabilitation models, which will then be promulgated across the NHS.
Implementation and further development of higher intensity care models for stroke rehabilitation are expected to show significant savings that can be reinvested in improved patient care. This includes reductions in hospital admissions and ongoing healthcare provision. Out of hospital, more integrated and higher intensity rehabilitation for people recovering from stroke, delivered in partnership with voluntary organisations including the Stroke Association, will support improved outcomes to six months and beyond.
By 2021, where appropriate, every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support. This will be delivered in line with the NHS Comprehensive Model for Personalised Care. This will empower people to manage their care and the impact of their cancer, and maximise the potential of digital and community-based support.
Funding for community and primary care services
We commit to increase investment in primary medical and community health services as a share of the total national NHS revenue spend across the five years from 2019/20 to 2023/24. This means spending on these services will be at least £4.5 billion higher in five year’s time. This is the first time in the history of the NHS that real terms funding for primary and community health services is guaranteed to grow faster than the rising NHS budget overall.
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