My name is Dr Majid Akram, I'm a general practitioner in
Market Deeping at the Deepings practice in South Lincolnshire. I work in a large size
practice 24,000 patients in a semi-rural location with 15 GPS, nine nurses
dispensers, allied health professionals, nurse practitioner and now
our extended scope physiotherapist
In 2016/17 we conducted an audit over a one-week period looking at what our
clinicians in the building were seeing face to face. And interestingly what we
found is that around 22% of our face-to-face contacts on a weekly basis
related to musculoskeletal problems. We had potentially found a segmented
section of our GP force's workload that we we thought we might be able to
transfer to another clinical professional. Our local CCG agreed to fund
a physiotherapist for a period of six months and in doing so together we would
try and establish whether there was a return on investment in relation to this
service redesign.
Hi my name's Phil Richards I'm the musculoskeletal practitioner at The Deepings
Practice. The benefits for patients is they get early access to
musculoskeletal care. We get longer appointments in the GP as well so,
especially with like chronic musculoskeletal conditions, a lot of
patients need the time and understanding of the condition which
the GP doesn't always have that time resource to give, so that can be really
helpful for our chronic patients. In terms of things like injection therapy
they don't have to wait for a routine GP appointment if the GPs even do the
appointments - some patients will actually travel to secondary care, which is
costing a consultant or hospital appointment they can come and see me
that same week and have their injection from that for a lot of conditions.
They get access to the routine imaging analgesics, everything just a lot quicker
and it's just overall been very successful we've had great feedback. I
think it also enriches the GPS knowledge of musculoskeletal - care I do
training for them and have discussions with them and they still see a lot of
musculoskeletal patients so I think it just kind of boosts the specialism and
and the generalism for me as well.
I think overall this is a really good example of a win-win-win situation - so
it's been a win for patients: patients can see I musculoskeletal
practitioner within a couple of days if not within that week. Every time a
patient sees a musculoskeletal practitioner it frees up a GP
appointment so actually it's very good. The other win has been for the practice
itself. So on average the musculoskeletal practitioner is able to see
around 350 to possibly 400 patients on a monthly basis. We have been able to shift
around 40% of our musculoskeletal face-to-face contacts from GPs to the
musculoskeletal practitioner. And actually the other win is the system
win for the CCG and the wider health economy so we
have been able to reduce outpatient elective activity, actually standardising
care and actually channeling it through one individual, has enabled us to reduce
the cost of investigations and inappropriate investigations and
actually interestingly the physiotherapist is actually promoting
self-care in a better way because he has more time with these patients, so
actually our prescribing costs have gone down. I think the pilots been fantastic
in that it's allowed us to modernise and reform the way we deliver
musculoskeletal care for our local patient population. For me it sounded really good
on paper but I was really interested to see how it would work and I think it's
worked actually really really well I would thoroughly recommend it nationwide
I think it's just overall been a great service to people.