buzzing with ideas for greater manchester · sustain positive behaviour change. all staff are...

Physiotherapy: buzzing with ideas for

Greater Manchester

2017

www.csp.org.uk/greatermanchester 3

Physiotherapy prevents and reverses damage and disability.

It is based on a social and

empowering model of care putting patients in the driving seat of their own health.

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Physiotherapy maximises independence, minimises disability and reverses damage.

Physiotherapists are experts in musculoskeletal (MSK) health, rehabilitation and self-management for people with a range of long-term conditions.

They are autonomous, regulated practitioners, qualified to independently assess and diagnose, and to identify and manage patient risk effectively.

Improving system efficiencyPhysiotherapy staff work at the interface between settings and are key to joining up services, reducing admissions to hospital and shortening the length of time people spend in hospital.

Many advanced practice physiotherapists can prescribe medicines, order and interpret investigations – freeing up the valuable time of GPs and consultants.

Physiotherapy for the greater good of Greater Manchester


1in5

£12milli n

One in five GP appointments

are with musculoskeletal

patients

Physiotherapists working within General Practice deliver the changes to primary care needed to improve population health.

MSK health problems account for 1 in 5 GP consultations(1, 3), are the most common cause of repeat appointments and results in high levels of unnecessary medicine prescribing and referrals for investigations and into secondary care.

The majority of these can be effectively supported by a physiotherapist without any need to see a GP.(4, 5)

General Practice physiotherapy posts and patient self-referral to physiotherapy services frees up GP appointments, cuts costs and reduces waste.

Nine out of ten GPs say they have confidence in the model(6) and it is backed by the Royal College of General Practitioners and the British Medical Association.(7)

4 The Chartered Society of Physiotherapy

how it works

Bury Integrated MSK Service in partnership with Bury CCG sees patients with MSK, rheumatology and persistent pain related conditions via a single point of access. 1914 patients accessed the service over 12 months, 75% were managed within the service and 226 steroid injections were administered freeing up valuable GP time. A telephone results service is convenient and provides faster access to specialist opinion. Community support services are also utilised to support patients’ self-management of long-term-conditions. 100% of service users stated they would recommend the service.

GM aim: same day access to primary care

In West Cheshire physiotherapy services across two NHS Trusts provide direct services for 36 GP surgeries. They have:• Saved GP /locum time – value

£540k / year • Decreased plain x-ray and MRI

referrals by 5.9% and 4.9% - value £111k / year

• Decreased orthopedic referrals by 2% - value £70k / year

• Reduced referrals for ongoing physiotherapy treatment by 3% - after a year-on-year increase of 12% over the previous 5 years

• 99 % patients rated the service good or excellent

• 91% GPs rated the benefits of the service to their practice at least 8 out of 10.

how it works

5

EVERY YEAR£12milli n

MORE PHYSIO WOULD PREVENT

8,423 SERIOUS FALLS IN GM SAVING THE NHS

GM aim: support for people to stay well and live at home for as long as possible, with 2,750 fewer people suffering serious falls


SP Therapy Services – a private clinic in Bury has appointed one of their physiotherapists to be their first Balance Champion. She supports an 8 week falls prevention programme, which includes community based exercise classes, part of an ongoing collaboration with the Bury Wellbeing initiative to promote active ageing. So far, all participants in the programme reported that they felt that their physical abilities had improved, and 20% show a reduced risk of falling, through an improvement in their sit to stand test. The Balance Champion also spends a proportion of her week spreading best practice, forming strong links with local housing groups and charities like Bury Age UK and Bury Dementia Action Alliance, giving talks to local community groups and linking with health promotion groups such as Bury I will if you will.

Physiotherapy support workers and therapists reduce the risk of falling, through enabling people to strengthen bones, increasing muscle strength and have the confidence to exercise safely.

Physiotherapy group exercise programmes reduce falls by 29% and the risk of falling by 15% and through individual exercise programmes by 32% and 22% respectively.(8)

If everyone aged 65 or over who are at risk of falling were referred to physiotherapy within Greater Manchester 8432 falls that would otherwise result in an A&E attendance would be prevented. This would save £12, 138, 983 from the devolved health budget in Greater Manchester(9), more if social care costs are taken into account.

Identifying those at risk of falling in order to get people the help they need can be done by any health and care worker or carer. The CSP has developed a guide that explains how: www.csp.org.uk/getupandgo

how it works

5

50%

6 The Chartered Society of Physiotherapy www.csp.org.uk/greatermanchester 7

Physiotherapy rehabilitation helps people to beat cancer through supporting physical activity and exercise.

Rehabilitation gets people back on their feet following surgery, illness or injury through exercise, education and support. If someone is coping with a long term condition, have fractured a hip or had a stroke, having rehabilitation after leaving hospital makes all the difference. It is the difference between regaining health and independence or being left in failing health and permanently disabled.

GM aim: 1,300 fewer deaths from cancer

GM aim: 580 fewer deaths from respiratory disease

Exercise can dramatically reduce mortality rates – for example by as much as 50% for bowel cancer. Disease progression can also be reduced by exercise – by 57% for people with prostate cancer.(10, 11)

Chronic obstructive pulmonary disease (COPD) is in the top five conditions accounting for emergency and unplanned hospital admissions.(12) Physiotherapy staff run pulmonary rehab classes for COPD patients – as a result they spend 50% less time in hospital and are 26% less likely to be readmitted after they’ve gone home.(13, 14)

Community rehabilitationCOPD patients

who attend pulmonary

rehab classes spend

50% less time

in hospital


how it works

The Salford Royal Specialist Breast Care Physiotherapy ServiceResearch shows that for a proportion of the three million people diagnosed with breast cancer annually, life prolonging treatments are associated with complications and side effects that can lead to functional limitations and disabilities.(16) The Salford Royal Specialist Breast Care Physiotherapy Team was established in 2010 as part of the multi-disciplinary outpatient service, to tackle this issue. The team supports patients at all

stages during their breast cancer journey, through physiotherapy treatment and supported exercise – for example running pilates classes for people with breast cancer. This Gold Standard service supports people to regain their mobility and function, and improve their quality of life through a physically and emotionally testing time. It is often described as the ‘eyes and ears of the service’. “A personal and caring team who treat every patient as an individual” - patient testimonial


GM aim: 600 fewer deaths from cardiovascular disease

Physiotherapy staff run cardiac rehab programmes – which reduce mortality, improve health, improve quality of life, and reduce the length of hospital stays and readmissions.

NICE advises that cardiac rehab is cost effective, and each Quality Adjusted Life Year gained by a patient costs £8000, far less than the level they consider affordable (£20,000 - £30, 000). (15)

Half of patients with cardiovascular disease have additional health problems – back pain, arthritis, diabetes or COPD. Without expert support, these can be a barrier to the physical exercise necessary to get back to health.(17, 18, 19)

Community rehabilitation

The sooner someone can get access to advice and support from a physio the less time they will need to be off work.

8 The Chartered Society of Physiotherapy www.csp.org.uk/greatermanchester 9

MSK is the second largest cause of sickness absence. Early access to physiotherapy benefits individuals, workplaces and the economy.(20)

The government is now actively looking into physios issuing fit notes, which would further reduce demand for GP appointments.(21)

The sooner someone can get access to advice and support from a physiotherapist, the less time they will need to take off work and the less risk there is of acute problems becoming chronic.

For most people in Greater Manchester this means being able to quickly and easily see a physiotherapist within primary care.

Those who work for larger firms can benefit from access to physiotherapy

John Lewis staff reporting an injury receive a triage call from Physio Med within four hours, and initial assessment from a physio within three days. Over 12 months 2,324 staff engaged with the service and JLP estimated it saved 41,010 working days and £2,676,000.

100 fire brigade staff with chronic MSK conditions followed a programme provided by Crystal Palace Physio Group including work-specific exercises. There was an 85% reduction in time off work – a £27 return on every £1 spent.

Physiotherapists from Pennine Acute Hospitals NHS Trust have introduced‘Health Chats’ into their patient consultations, to support patients in making healthy lifestyle choices to sustain positive behaviour change.

All staff are trained to have brief conversations in: becoming more physically active, stopping smoking, healthy weight, safe alcohol limits and mental health issues.

The service has formed partnerships with and signposted to over 20 public, private and voluntary sector support organisations.

Documented ‘Health Chats’ rose from 24% to 74% over an 18-month period.

GM aim: a healthy workforce how it works

as part of occupational health services. Large employers who have done this say it saves money and improves productivity.

A GM stakeholder In Greater Manchester the Chartered Society of Physiotherapy (CSP) has 2, 286 members, made up of registered physiotherapists, physiotherapy support workers and students.

The CSP represents 90% of all registered physiotherapists. We are active locally and committed to working with the Greater Manchester Combined Authority, commissioners, providers and community organisations to improve the health and wellbeing of people in Greater Manchester.

A GM assetThe physiotherapy workforce is a Greater Manchester asset that should be utilised – both looking at how the existing workforce can work in new ways and ensuring sufficient workforce supply.

Physiotherapy programmes are over-subscribed and because of the shortage of physiotherapists, courses recruit well and graduates find it easy to find work.


Greater Manchester can unlock this potential by:

✔Deploying physiotherapists with advanced practice skills in primary care – directly accessible to patients

✔ Increasing the number of physios qualified as independent medicine prescribers

✔Prioritise community based rehabilitation to keep people out of hospital

✔Work with Manchester Metropolitan University and University of Salford to increase the number of physio graduates

✔Expanding the physiotherapy support workforce working under the direction of registered physiotherapists

✔Strengthening physiotherapists’ involvement in research collaborations to inform innovations in service delivery.

Physiotherapy supports people across a wide range

of long-term conditionswww.csp.org.uk/greatermanchester 9

The Physiotherapy Workforce

www.csp.org.uk/theevidence

WE COVER MORE THAN YOUR BACK

StrokeFallsCancerLung diseaseHeart problemsRehabArthritisDiabetes

Child disabilitiesMS

Parkinson’sMental healthPelvic healthLearning difficulties

References1. Arthritis Research UK National Primary Care Centre. What do general practitioners see? . Musculoskeletal Matters Bulletin no1. 2009 https://www.keele.ac.uk/media/keeleuniversity/ri/primarycare/bulletins/MusculoskeletalMatters1.pdf

2. Jordan K, Clarke AM, Symmons DP, et al. Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases. Br J Gen Pract. 2007;57(534):7-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2032694/pdf/bjpg57-007.pdf

3. Royal College of General Practitioners Birmingham Research Unit. Weekly returns service annual prevalence report 2007. London: Royal College of General Practitioners 2007.

4. Landen Ludvigsson M, Enthoven P. Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Physiotherapy. 2012;98(2):131.

5. Bishop A, Ogollah RO, Jowett S, et al. STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain. BMJ Open. 2017;7(3) http://bmjopen.bmj.com/content/bmjopen/7/3/e012987.full.pdf

6. Wallce F, Harper J, H S. Primary healthcare monitor 2016. London: nfpSynergy; 2016.

7. The Chartered Society of Physiotherapy, British Medical Association, Royal College of General Practitioners. Implementing physiotherapy services in general practice: a guide for implementation and evaluation. London: The Chartered Society of Physiotherapy; 2016 http://www.csp. org.uk/publications/implementing-physiotherapy-services-

general-practice-guide-implementation-evaluation

8. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007146.pub3/abstract;jsessionid= 6EE7BF916212CABAFF1602C7965ABCCC.f03t01

9. The Chartered Society of Physiotherapy. The falls prevention economic model. London: The Chartered Society of Physiotherapy; 2016. http://www.csp.org.uk/documents/falls-prevention-economic-model

10. Macmillan Cancer Support. The importance of physical activity for people living with and beyond cancer: a concise evidence review. London: Macmillan Cancer Support; 2011. https://www.macmillan.org.uk/documents/aboutus/commissioners/physicalactivityevidencereview.pdf

11. Richman EL, Kenfield SA, Stampfer MJ, et al. Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor. Cancer Res. 2011;71(11):3889-95. http://cancerres.aacrjournals.org/content/canres/71/11/3889.full.pdf

12. Blunt I. Focus on preventable admissions: trends in emergency admissions for ambulatory care sensitive conditions, 2001 to 2013. London: Quality Watch; 2013. http://www.qualitywatch.org.uk/sites/files/qualitywatch/field/field_document/131010_QualityWatch_Focus_Preventable_Admissions.pdf

13. Seymour JM, Moore L, Jolley CJ, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;65(5):423-8.

14. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362-8.

15. Fidan D, Unal B, Critchley J, et al. Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010. QJM. 2007;100(5):277-89.

16. Pidlyskyj K, Roddam H, Rawlinson G, et al. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy. 2014;100(2):156-61.

17. British Heart Foundation. The National Audit of Cardiac Rehabilitation: beating heart disease together - Annual Statistical Report 2010. London: British Heart Foundation; 2010. http://www.cardiacrehabilitation.org.uk/docs/2010.pdf

18. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001(1):CD001800 https://www.ncbi.nlm.nih.gov/pubmed/11279730

19. Department of Health. Coronary heart disease and the need for cardiac rehabilitation. London: Department of Health; 2010.

20. Office for National Statistics. Sickness absence in the labour market: 2016. London: Office for National Statistics; 2016. https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016

21. Department of Health. General Practice Forward View. London: Department of Health; 2016. https://www.england.nhs.uk/gp/gpfv/

ContactCSP North West Chair Joanne Lishman MCSP BSc (Hons) email: [email protected]

CSP Enquiries Team tel: 0207 306 6666 email: [email protected] web: www.csp.org.uk

The professional, educational and trade union body for the United Kingdom’s 56,000 chartered physiotherapists, physiotherapy students and support workers.

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