NHS Brent Clinical Commissioning Group (CCG) is responsible for a population of approximately 375,305 patients across 54 practices. They selected Connect Health in January 2019 to provide the Community Physiotherapy Service for the patients of Brent. In October 2019 the contract was extended to include a Tier 2 Clinical Assessment and Triage Service (CATS) which provides a single point of access gateway for musculoskeletal (MSK) health, rheumatology, pain, women’s health, orthopaedics and diagnostics.
As part of the NHS Brent Out of Hospital Strategy, the redesigned community physiotherapy services provision and new clinical model aimed to ensure that referrals are dealt with quickly by qualified and experienced practitioners, ensuring rapid access to the right point of care.
Problems to be solved prior to January 2019 by the new service
- There was a significant backlog of over 4000 patients in the service
- There was a 12 week wait for an MSK physiotherapy appointment
- Long delays for an appointment meant conditions became more chronic in nature leading to potential implications on physical and mental well-being as well as potential financial implications for work and home
- The delay often means more physiotherapy appointments are required within their treatment cycle which has a negative impact upon administrative and clinical resources
- GP referrals being sent to secondary care were very high
- Many patients were referred for conditions that didn’t need secondary care input
- Brent had a very high usage of services across outpatients and imaging
- There was an urgent need to streamline the service in order to help the wider system
It’s unusual for a physio service to have so many multiple language speaking clinics. We try and match the right clinician with the patient and offer 11 languages, as well as having a web and telephone based interpreter service.
We offer a specialist community Women’s Health service and receive GP referrals for gynaecology and obstetric conditions.
Service outcomes – reductions in secondary care
- Connect Health successfully cleared the inherited 4,000 patient backlog within 6 months.
Primary care education
- Reduced referrals to secondary care required a high level of collaboration within the GP community. Connect Health regularly attends GP meetings.
- Just 4% of referrals into CATS are referred to secondary care
- 21% reduction in GP referrals to first appointment for Trauma and Orthopaedics April 19 – Mar 20
Service outcomes – reductions in diagnostics
- Direct access MRI requests, GP referred, all providers, reduced by over a half April 18-Feb 20
- Cost of direct access MRI requests was down from £140.3k in May 2018 to £47.6k in Dec 2019
- Ultrasound referrals reduced by 55%
- Just 1% of cases required imaging
Impact on patients
- 80% of patients would recommend the service to family and friends (based on independently collected data)
Quality of life improved by 23%
- Patients have shown an improvement in EQ5D score, with an annual improvement score averaging at +0.23 (compared to the average of previous studies of +0.16) based on data March 19-March 20
Extremely rapid response. One thing I really liked is that the exercise programme is at the right level and takes into account that I’m active. The physio provided updated information on my condition and recommended activities as I’d been following outdated advice. Really happy.
Impact on staff
We are pleased to offer patients a range of ways to access services via PhysioLine (telephone), PhysioNow (online), video call appointment or face to face, all within a couple of weeks. We have a huge gym facility in two locations in Brent. The facilities we have here are pretty special
Daniel Townsend, Advance Physiotherapy Practitioner, Clinical Lead
Onward referrals are quicker than the traditional route. Previously, you would write back to the GP with your recommendation which meant a long wait. The CATS team is extremely helpful and can get the patient to the correct speciality quicker, essentially providing a better patient care.
Why Connect Health as a partner?
We have worked with Connect Health partners to ensure that our patients receive the best care possible in a timely manner. The recent MSK patient self-referral pathway has increased access for our patients and it is a service development that has been welcomed by our residents and primary care colleagues.
Dr Madhukar Patel, Chair of Brent CCG
Working with Connect Health has been a really innovative collaboration between commissioner and provider and the benefits have been felt all around.
The patient facing aspect has seen fast appropriate care being delivered in community settings with a range of different modalities and languages to accommodate our diverse population.
With regards to the local GPs, there has been continued engagement and the team have been responsive to the local GP’s needs by also providing advice and education throughout the contract.
In terms of the impact on the delivery of good quality healthcare, we have seen a significant reduction in the use of diagnostics and also a reduction in unnecessary referrals into secondary care which ensures all aspects of the whole system is being used more appropriately.
As a service, this has been a pleasure to have developed and the Connect team has helped achieve our vision for an unrivalled MSK Service for the patients of Brent.
Dr Shazia Siddiqi – GP Lead Brent CCG