Joint effects 2011 - An update of the involvement - 18 Weeks

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Joint effects 2011 ESP Orthopaedic Foot and Ankle Triage Service Paul Higgins paul.higgins@ggc.scot.nhs.uk 0141 211 1425 MSK Physiotherapy Service Review Heather Cameron heather.cameron@ggc.scot.nhs.uk 0141 211 8562 ESP orthopaedic foot and ankle triage services were set up in the community in 2004. Orthopaedic waiting times were around 18 months and the surgical conversion rate averaged 30%. The service received the national AHP award for best innovative service in 2007. The service continues with a surgical conversion rate for foot and ankle patients of 90 – 95%. Permanent funding for the two whole time equivalent (wte) posts was secured in 2008. Patients wait a maximum of six weeks from referral to being seen. The service contributes to reduced orthopaedic waiting times, frees up consultant time, ensures patients are seen by the best person and provides a local service to the community. Over 72,500 patients are seen each year in the NHS Greater Glasgow and Clyde (NHS GG&C) physiotherapy musculoskeletal services. Currently delivered in 30 community sites and nine acute sites including clinics, health centres, hospitals, leisure centres, and other community centres throughout NHS GG&C. The MSK physio service employs 154.4 wte physiotherapy staff (75.19 wte in CH(C)PS and 79.21 wte in acute sector). A redesign of MSK services is currently underway, due for implementation early 2012 which will streamline services and improve accessibility and efficiency. Patients can access physiotherapy via a number of routes: self, GP or consultant referral. The majority of sites offer self referral – most patients use the telephone but some sites also offer drop-in sessions. Extended Scope Physiotherapists (ESPs) work across GG&C in acute hospital settings; the ESPs triage orthopaedic referrals and have a key role in patients pathways, ordering investigations and listing for surgery where appropriate. Glasgow Back Pain Service (GBPS) has a well established pathway for people with low back pain providing speedy access for those who may require it to specialist physiotherapy advice and/ or investigation / onward referral. This service has also recently been extended to include Clyde. 32 mskscoping2011-rs.indd 32 03/11/2011 11:01
Joint effects 2011 MSK Outcome Measure Proforma Karen Glass karen.glass@ggc.scot.nhs.uk Many MSK clinicians were only recording VAS pain scales as an outcome measure. Impact of the service on service users in any improvement in function, work or physical activity could not be demonstrated. Validated outcomes of pain VAS and function (from ‘patient functional scale’) were combined with non-validated outcomes related to work status and medication consumption and a record was kept of health improvement discussions: physical activity, alcohol intake, smoking and weight. Outcomes were recorded in discussion with the patient rather than strictly patient reported or therapist reported. The ‘new’ MSK outcomes proforma was piloted in February 2010 and with minor changes rolled out and audited in October 2010. The Clinical Governance Support Unit is processing the data and a draft report is now available. One Stop Rheumatology Foot Service – a partnership with Glasgow Caledonian University Mhairi Brandon mhairi.brandon@ggc.scot.nhs.uk The MDT foot clinic coordinates rapid investigations such as diagnostic ultrasound and gait analysis to facilitate treatment planning and evaluation. This clinic has been developed as a onestop shop, specifically for the management of patients with complex lower limb problems. The MDT foot clinic is linked with the Foot and Ankle Research Group based at Glasgow Caledonian University and provides the opportunity to undertake audit and facilitate research. The specialist experience gained by running this type of clinic will also provide the opportunity to develop capacity and capability in ultrasound imaging, injection therapy and research for AHPs. This one-stop approach resulted in 75% of patients not requiring any further input AHP input following that episode of care, 5% were fast tracked to Orthopaedics for a surgical intervention and 20% were sent for additional medical management relating to their ongoing rheumatological condition. Pain Services Aline Williams and Linda Sparks aline.williams@ggc.scot.nhs.uk Specialist physiotherapists work within the pain services in the acute division as part of a multidisciplinary team. In addition to providing specialist advice to patients they also deliver training and education to other MSK physiotherapists. A multidisciplinary pain management programme has been established. 33 mskscoping2011-rs.indd 33 03/11/2011 11:01
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