Self-referral to physiotherapy

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A case study from Salford Royal NHS Foundation Trust, examining a programme allowing patients with musculoskeletal (MSK) conditions to access a trust's physiotherapy department without seeing their GP first.

What was the problem?

About 20% of GP appointments relate to MSK conditions.

Every time a patient wants to access physiotherapy services, they must wait to see their GP, then once referred, wait again to see a physiotherapist.

The Chartered Society of Physiotherapists found in surveys that 88% of patients would prefer to refer themselves to physiotherapy rather than attend their GP surgery first.

What was the solution?

Phase 1 - pilot

An initial 12-month pilot project named 'go2physio' that enabled patients to go to the trust's physiotherapy department without seeing their GP first.

The intention was for 50% of patients with MSK conditions to directly access physiotherapy services by September 2017, reducing GP MSK appointments.

The trust was well placed to help shift demand from GPs as the department received about 1,240 referrals a month.

The project adopted the Model for Improvement approach, and the clinical lead spent 12 months as a clinical fellow at the Haelo Innovation and Improvement Science Centre in Salford.

Phase 2 - city-wide implementation

To prepare for extending go2physio city-wide when the pilot was complete, teams of physiotherapists and GPs tested ways of telling patients about the change, including:

  • traditional leaflets and posters
  • Facebook adverts
  • targeted mailshots
  • Twitter
  • text messages.

What were the challenges?

  • engaging local teams in the 90-day rapid cycle of improvement collaborative, including funding backfill GP time spent attending project events
  • learning a new approach to improvement — the Model for Improvement — while delivering the project
  • lack of a self-referral option on the NHS e-Referral system — used for all GP referrals in Salford — which increased the administrative burden for access, choice and booking staff
  • creating a digital online form for patients to self-refer

All these challenges were successfully overcome.

What were the results?

go2physio exceeded the target of 50% of patients referring themselves (results in pdf below):
  • eighty per cent of go2physio patients are appropriate referrals, with 13% requiring signposting and further management, according to a clinician perception survey
  • waiting times have not increased, with a median of 35 days from referral to appointment

Comments from patients included:

  • ‘I don't know where I would have been without you.’
  • ‘It's the best way.’
  • ‘Much easier.’
  • ‘It was quick and exactly what she wanted.’
  • ‘It is an excellent addition, if it relieves GPs so that when you do need a GP you can get an appointment more easily.

go2physio has enabled the trust's physiotherapy department to improve links with GP practices and raise awareness of physiotherapy in Salford.

What were the learning points?

  • a robust methodology and framework need to underpin any improvement project
  • plan-do-study-act cycles were instrumental in the project's success
  • collaboration is key — ensuring the right people are in the room and engaged
  • leadership is vital, as is time out from managing a clinical workload

Next steps

The trust is testing local residents' awareness of go2physio to decide future marketing. Further work is being done on care navigation to go2physio in primary care.

Want to know more?

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