Setting the scene – working together

Setting the scene – working
together
Chartered Society of Physiotherapy MSK
Local Area Team (MLAT) Network
Physiotherapy Workforce
– Physiotherapists employed by the NHS in England (all bands):
26,971*
– Physiotherapy HCPC Registrants in England: 38,440**
– Student intake for England over the last five years;
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2013/14 – 1696
2012/13 – 1648
2011/12 – 1738
2010/11 – 1863
2008/09 – 1846
– Approximate 50% of UK physiotherapists have musculoskeletal
speciality
*accurate as of Nov 2014
**accurate as at Nov 2013
Training and variety of profession
• University degree or pre-registration masters for entry
• 1000 hours of clinical practice pre-registration
• Early career typically around a variety of clinical areas
before specialisation
• Autonomous profession regulated by the Health and
Care Professions Council (HCPC) – reregister every two
years
• Committed to continued professional development and
post-graduate training.
Key attributes of physiotherapists
• Breadth and depth of qualifying training
• Strong foundations in the ‘medical model’ but also the
‘bio-psychosocial model’ of care
• First contact diagnosticians & practitioners
• Perform essential diagnostic & therapeutic roles
• Work across healthcare spectrum (NHS, social care,
public health & private practice)
• Work throughout the public health-wellbeing-illnessrehab spectrum
Key points for Physiotherapy from
Five Year Forward View
• Increased emphasis on preventative services
• Patient empowerment
• Engaging with communities and citizens (asset
based approaches / social value)
• Greater integration between primary, community
and hospital services
• Greater emphasis on localism
Physiotherapy offer – 5 R’s
Professional
Body
CSP
Educational
Body
Trade Union
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Examples of successful CSP network
collaborations
Stroke audit (ACPIN)
Intermediate care audit (AGILE)
DH AHP rehabilitation strategy (CSP)
Allied Health Professions Federation (Professional bodies)
National AHP Informatics Strategic Taskforce (Professional
bodies)
• Continence position statement with RCM (POGP & CSP)
• DWP whiplash (MLACP & ACPOHE)
Musculoskeletal Local Area Team
Network (MLAT)
CSP perspective – why network?
Reasons for engaging with developing networks:
• Intelligence sharing
• Local influencing
• Commissioning Support
• Platform for multidisciplinary collaboration
• Allocation of CSP resources
Evidence that collaboration is better
Post- hip fracture
• The innovative Bradford Teaching Hospitals NHS
Foundation Trust Early Supported Discharge
(ESD) pathway helps people regain their
independence and function following hip fracture
or other orthopaedic problems(14):
– Saved the Trust 2,698 orthopaedic bed days equating
to an estimated cost savings of more than £600,000.
– Readmission rates fell from 10-12% to 5-6%
Community Rehabilitation
Barking, Havering and Redbridge CCG redesigned
services to deliver more responsive care and
rehabilitation, from 8am-8pm seven days a week, in
the individual’s home. They have been able to
demonstrate(13):
– Very high levels of patient satisfaction
– A more rapid recovery (9 days versus 21 in hospital)
– Improvements in outcome (94% of patients improvement
in timed up and go)
Physiotherapy in A&E
• MSK Triage(12)
– Advanced Practitioner role within A&E (Salford Royal NHS
Foundation Trust)
• Minor to moderate MSK injury seen by Physiotherapists
– Managing wounds
– Ordering and interpreting X-rays/Scans/Blood tests
– Independent prescribing
– Estimated savings of £32 per patient compared to original
pathway
Intermediate care: Systematic reviews
• N = 34 studies for review plus
focus groups
• Optimal triage if:
– face to face
– As part of an inter-professional
pathway and team
– various practitioners suitable, if
experienced
– Patients most concerned re access
• N=23 studies, variable quality
• 72-97% managed within i/m care
• 20-60% reduction in referral rate to
orthopaedics
• PROMs data limited but positive
• High patient satisfaction
• A = YES, but cost-effectiveness data
inadequate
What optimises inter-professional
Clinical
collaboration?
Pathway clarity
decision
Robust
feedback
loops
Experience
Data
Excellent
relations with
commissioners
making
clarity
Beacons
Co-location
Respect
Interprofessional
working
An MSK
Network
Freedom
to act
[email protected]
0207 306 6663
@thecsp