Integrating a request for assistance model within the East Lothian MSK physiotherapy service

ABSTRACT

Keywords eHealth;Musculoskeletal;Service development Purpose: East Lothian Health and Social Care Partnership (ELHSCP) aimed to transform physiotherapy service provision by utilising a Request for Assistance (RFA) model in accordance with the Scottish Government's Active and Independent Living Programme. Technological options including telephone triage were explored to provide this. Development of this service was accelerated due to Covid-19. Aims: 1. Create a single point of access to physiotherapy, with referral to onward services across East Lothian as appropriate. 2. Successfully address people's needs through early intervention and promote self-management. 3. Entrench a patient-focused approach with streamlined processes and pathways. 4. Reduce waiting times for MSK Physiotherapy and GP Practices, saving cost and improving patient experience. Methods: • The MSK Advice Line opened in June 2020 and was based on a RFA service model. • The service was provided by Advanced Physiotherapy Practitioners (APPs) who used advanced critical thinking and expert clinical and diagnostic reasoning skills to facilitate a patient-centred management plan. • Access to the service was made by self-referral. Patients contacted a central number and were offered a telephone assessment. • Following assessment and diagnosis, management options were discussed and decided upon in partnership with the patient. • Due to Covid-19 remote platforms were utilised, with the option of escalation for face to face assessment or onward referral, in line with Government guidelines, as appropriate. • Regular service development huddles were established to ensure consistent service provision across the team and create learning opportunities. • Meetings were arranged with GP Practices in East Lothian to improve communication and build effective working relationships. Results: Over 6000 patients contacted the RFA phoneline • Patient Outcomes: 1. 58% of patients were converted to ongoing physiotherapy treatment, either remotely or face to face. 2. 40% of patient were happy to self-manage and required no further input. 3. 2% of patients were referred onward to other services or did not answer their phone. • A Patient Satisfaction Questionnaire was undertaken 1. 58% reported the service as excellent. 2. 13% rated it as great. 3. 29% rated it as good. 4. 77% of respondents were happy with remote service. • GP Outcomes 1. High levels of satisfaction among GP Practices was noted. 2. 31% reduction in requests for MRIs from GP Practices in East Lothian since launch. Conclusion(s) Implementation of the MSK Advice Line has demonstrated that the RFA model can be successful in creating a single point of access to physiotherapy services, ensuring patients are successfully directed to the most appropriate service to suit their needs. Evidence shows high levels of patient and GP satisfaction. Suggestions for future work include an ‘online chat’ function to support access routes for the younger population and the ability for APP's to request imaging and onward referral to secondary care. Impact 1. Reduce physiotherapy waiting time. 2. Improve patient journey. 3. Decrease prescribing and imaging requests, in line with new guidelines. Due to the success of the MSK Advice Line, the RFA model will continue to be a core component of the MSK physiotherapy service and will be rolled out across other services within the ELHSCP. Funding acknowledgements Not funded.