MSK First Contact – Making access to physiotherapy easier in Alton01/04/2019

John Jones – Alton MSK First Contact Patient

Musculoskeletal (MSK) issues can account for a huge array of common problems and take up 20-30 percent of a GP’s appointments. They can include conditions like osteoarthritis, sprains, repetitive strain and back pain. Traditionally, if you are suffering from an MSK related problem, you would visit your GP who would refer you to see a Physiotherapist. Then you’d have to wait around six weeks for the appointment and travel to a specialist centre or hospital for it.

Under the MSK First Contact project, you can go straight to the Physiotherapist and see them for an assessment within days at your own, or a neighbouring, practice. Currently being piloted in the Alton area, patients of Chawton Park Surgery, the Wilson Practice, Boundaries Surgery and Bentley Village Surgery have access to a Physiotherapist every week.

When patients over 15 years old call to book an appointment, the receptionist answering will ask for a rough outline of the problem. If it is something MSK-related and meets the pilot criteria they are given, they can book the patient straight in to see the Physiotherapist – usually within a few days. Not only is the Physiotherapist able to give more specialist advice to the patient right from the start, they are also allotted slightly longer appointments than a GP, allowing them to spend more time assessing the patient and offering appropriate advice.

The Physiotherapists can often diagnose the problem and are able to suggest helpful exercises and a treatment plan. They can refer the patient on to the hospital for a course of physiotherapy if necessary and liaise with the GP to order prescriptions, or issue fit notes when the person is unable to work.

The pilot has been running for a year now and has proved extremely popular. Now that the word is out, patients have even begun to specifically ask for the service, instead of going straight to their GP as a first port of call.

One such patient is John Jones, a long time patient of Chawton Park Surgery. Last year he damaged his knee badly and was experiencing a lot of pain, which spread to his hamstring. John is a keen rambler and the problem was starting to interfere with his ability to walk comfortably. Countryside stiles in particular were becoming a real issue, as stepping up and pushing off on his knee caused him significant pain.

Like a lot of people he soldiered on and hoped it would get better and go away on its own, but after a few weeks his wife, Pam, pushed him to take up the physiotherapy service she had heard about. He booked the appointment and within days was able to be seen by the Physiotherapist.

She took the time to assess John’s knee and diagnosed the problem as a sprain, recommending that he give the knee plenty of rest and be patient whilst waiting for it to heal. “The best thing about it was the reassurance,” John said of his consultation. “It was a great weight off my mind to know that it was nothing more serious and that it would get better.” Within a few weeks his knee healed and the problem went away on its own, as the Physiotherapist had advised it would.

John knows first-hand the benefit of having the physiotherapist so easily accessible. Some years ago, long before the MSK First Contact initiative was conceived, he began to suffer from severe back pain. His GP referred him to a Physiotherapist at the hospital, but the appointment was several weeks away. In the meantime John tried everything to ease his discomfort, including private chiropractic treatment and acupuncture, but neither made much difference.

During one of his sessions at the hospital, the Physiotherapist noticed that when John stood, one of his hips was lower than the other, so she gave him exercises to do that would realign them correctly. Within a week John felt better and was soon back to his old self.

This time around John’s experience couldn’t have been more different. “I didn’t have any hesitation about going straight to the Physiotherapist without seeing my GP first,” he says. Had a service like MSK First Contact been available to him when he injured his back, John would have been seen by the right specialist almost immediately, and could have saved himself a lot of time, money and pain.

The service has led to a number of other positive outcomes in the wider healthcare community. In addition to making it much quicker and easier for patients to access the right specialist treatment, the scheme has the added benefit of freeing up GP’s time for other appointments. By working together more, GP’s are also able to build stronger relationships with the Physiotherapists and opportunities often arise for both sets of professionals to learn from each other and expand their skills and knowledge.

Another outcome of the pilot has been a reduction in wasted physiotherapy appointments at the hospital. Patients with mild conditions, like John’s, often find that their problem has resolved itself by the time their hospital appointment comes around. Unfortunately when this happens, many patients don’t call to let the hospital know that they no longer need their slot and instead let it go to waste. Since the scheme has been running the number of missed appointments has been seen to dramatically reduce.

Nicky Maule, Practice Manager at Chawton Park Surgery, was thrilled at the success they have seen. “The physiotherapy appointments have proved extremely popular and there are so many other benefits attached to them. It’s been a great learning curve and there have only been a few minor wrinkles along the way to get it working smoothly. I’d definitely recommend the service to patients and other groups of practices.”