Right sizing to survive…

The difficulties facing NHS Physiotherapy managers … and in Our Virtual Clinic….Our Physio Direct service gains the human touch…

During a recent CSP’s ‘Survival Guide for Managers’ I was able to gauge the levels of concern from NHS physiotherapy managers for MSK services. There was broad agreement that a NHS Outpatient department will need to be dynamic, accessible and efficient to compete against the private sector. One of the barriers that NHS managers consistently reported was the contract terms for NHS staff that made redundancy too expensive to implement. As a consequence their entire MSK service is placed in jeopardy as a bloated work force struggles to compete against a fleet footed, flexible work force in the private sector. Although other initiatives were discussed such as MSK telephone based triage (see Our Virtual Clinic on previous blogs), it was considered it would still not be able to trump the cost and quality of an estimated £23 for a Face to Face treatment session with the local, private provider.

A more positive outlook might be that NHS departments step away from tendering for highly competitive work such as MSK services and seek opportunities that play more to their strengths. I spoke to one NHS manager today who said that whilst it was unsustainable to provide direct access to MSK outpatients there were still opportunities to win services within the tendering process. Outpatient services such as respiratory and neurological rehabilitation are areas of care where patients establish longer term relationships with their trusted clinician and within the NHS setting are less likely to experience the higher turnover of staff in the private sector.

Our Virtual Clinic : Our Physio Direct service embraces a Walk – In service

Our Physio Direct service has been working well. We have reduced the numbers of face-to-face referrals to our Outpatient department by 50% by providing exercise and advice over the phone. However we have found that getting the staffing numbers has sometimes been difficult. It can sometimes be all feast or all famine.

We cannot have physiotherapists idling during the quiet times. We have now set up a Fast Access to Physiotherapy service, which allows patients to drop in during our working hours. Patients are made aware that we will do our best to see them within 30 minutes of arriving in Reception.

The length of the face-to-face session will be highly dependent on how busy our telephone triage service is and how big the demand is in the Walk in center. We would aim to see them for a minimum of 10 minutes and they will then leave armed with an exercise program and advice.

Our physios are now manning phones but also juggling drop in clients. It can be hectic but at the same time dynamic and fun. Patients appreciate the ability to get a quick assessment of their problem and we intervene at the earliest opportunity reducing the risk of chronic conditions arising. We are feeling fairly smug in our virtual world but ultimately have to give full credit to Scott Hurford and team who are doing this for real in NHS Neath and Port Talbot. Thanks for letting me drop by last month.

As a footnote, remember my old physiotherapy colleague that told me that a 16 week wait for an outpatient appointment was good… because it was under 18 weeks (See Reducing face to face sessions…my dullest blog yet June 17 2011). That service has now closed as their service has been won by a private provider. Start redesigning now or I predict this will be the state of things to come.

In the next blog we will discuss… Have the Allied Health Professions made any progress in gaining credibility from those higher up the medical food chain?  And in Our Virtual Clinic… hold on to your gavels as we judge the possibilities of a new income stream….

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