C4CC partner, the Chartered Society of Physiotherapy (CSP), has been looking at how physiotherapy in primary care can transform lives, including giving evidence at the health select committee hearing on primary care, and a roundtable discussion with the National Association of Primary Care and fellow C4CC partner, NHS Confederation.
In a guest blog today, Professor Karen Middleton chief executive of the CSP discusses how empowering patients and expanding self-referral to physiotherapists can free up GP’s time and help reduce costs.
The increasing demand for health and social care services – fuelled by our ageing society and the growing number of people living with long term conditions – requires nothing less than a reimagining of the relationship between professionals and patients.
The language of co-production, conversation and community – as championed by the Coalition for Collaborative Care – is widely becoming the language of change in the NHS.
To transform rhetoric into reality, we must be absolutely clear what these concepts mean in practice.
Physiotherapists put patients in the driving seat by being asset focused – stressing what people can do rather than what they can’t – and developing strategies for self-management.
The Chartered Society of Physiotherapy’s most recent briefing highlights how physiotherapy can deliver this in primary care.
With nine out of every 10 patient interactions taking place in primary care, it is the frontline for collaborative care.
Meeting the needs of patients – and putting power into their hands – starts even before they set foot in a GP surgery or another community setting.
It starts with access.
For instance, if you call your local surgery you should be able to get an appointment with a GP or nurse – but not a physiotherapist.
Why should that status quo remain unchallenged?
The CSP has been calling for all patients with common problems such as back or neck pain to be able to choose to see a physiotherapist at their local surgery.
Patients with long term conditions live with, and manage them, on a daily basis. They are experts by experience and more often than not the best judge of what support they need.
Many GPs agree.
They know that musculoskeletal (MSK) conditions make up to 30 per cent of a GP’s caseload, yet 85 per cent of those people do not need to see a GP.
In pilot schemes from Wales to Cumbria to Hampshire they are opting to bring in physiotherapists to work alongside them as the first contact practitioner for their MSK patients. And patients are choosing to see them.
Physiotherapists can assess and diagnose patients and then begin offering treatment and advice straight away. This frees up GP appointments (more than 100m a year), reduces referrals to secondary care and could save the NHS £525m a year.
At present, the most common route into NHS physiotherapy in England is via a GP referral.
Self-referral is available in all areas of Scotland and two-thirds of Wales – and, of course, it’s the standard pathway into private treatment. However England lags behind, with self-referral only available in a third of areas.
Expanding the number of physiotherapists in GP surgeries and making self-referral available everywhere will give more patients more control. These services get people back to work quicker and improve self-management.
We need to make them the norm.
Once in the consulting room, physiotherapists understand that good care and good outcomes stem from good conversations. They take a proactive approach to making every contact count.
In the summer of 2014 a survey of CSP members revealed that the vast majority of physiotherapy staff already seize opportunities to have healthy conversations.
It is all in a day’s work.
Most importantly their advice is trusted by patients.
Research by the Royal Society of Public Health and Public Health England shows that 85 per cent of the public would be happy to get health advice and support on issues such as weight management, stopping smoking, healthy eating and cutting down on their drinking from physiotherapists and other Allied Health Professions (AHP’s).
All together AHP’s see about four million people a year.
That’s four million chances to affect positive lifestyle and behaviour change, maximise quality of life and reduce pressure on services by working with patients.
Of course, the ultimate aim of physiotherapy in primary care – and indeed the whole workforce – should be to support independent living and enable the fullest possible participation in family and community life.
After all, even people with long term conditions only spend a few hours a year with health and care professionals.
Falls and COPD are two of the leading reasons older people are admitted to A&E or secondary care or need social care , so there is an opportunity to make a major impact by investing in prevention and rehabilitation services.
The innovative approach being taken by Hope Street Specialist Service in Grimsby is to combine a medical model with a social context: offering individually tailored eight-week treatment and six-week education programmes, delivered by multidisciplinary teams and volunteer buddies (many of whom are former patients).
The service for patients with COPD and those who have experienced a fall is successfully reducing social isolation – with buddies forging networks for patients both inside and outside the clinic – as well as reducing A&E visits and hospital admissions.
Empowering patients to be active participants in decisions about their care and treatment – as opposed to passive recipients – is in the DNA of physiotherapists.
The ethos of physiotherapists has always been to work in partnership with patients to achieve their goals, and the CSP’s primary care briefing highlights further untapped promise.
Only by collaborating and putting patients in control can we improve public health and address the cost pressures faced by today’s – and tomorrow’s – NHS.