Physios ease CCG referral pain

A team of community based musculoskeletal (MSK) experts has helped improve surgical conversion rates by up to 50% in west London during the past five years.

MSK related conditions account for up to a third of all GP appointments in Ealing with hard-pressed doctors heavily reliant on secondary care for further investigations and treatments.

Research had shown that historically only 30% of GP hospital referrals go on to have surgery, known as the surgical conversion rate. 

This model of care was inefficient and left the CCG with an increasingly costly secondary care bill for outpatient assessments. These assessments could be delivered more cost effectively in the community with patients being seen in a more convenient location, closer to home.       

In response, the CCG commissioned an ‘interface’ service provided by Ealing Community Services which initially assesses patients in one of six community based locations to see if they are suitable for surgery.

The 12-strong team, which is comprised of specialist physiotherapists, two GPs with a special interest in MSK, a visiting neurosurgeon and two orthopaedic surgeons, provide a bridge between primary and secondary care handling up to 10,000 referrals a year.

Dr Stephanie Griffiths, Consultant Physiotherapist and Lead for MSK Service, said: “GPs want to do what is right for their patients and, in the past, often felt the best option was to make a referral as their own expertise of MSK was often limited.

“In reality, many MSK conditions do not require surgery, especially back pain for example where less than 1% of cases require surgery.”

“A lot of work goes into helping patients to understand their condition and teaching them the correct exercises so they can manage their problem if it returns.”

“GPs refer directly into our team who oversee diagnostics, tests, physiotherapy and, if appropriate, referral into hospital. As a result, the surgical conversion rate has improved to 81%”

The inclusion of GP specialists and consultants on the team albeit in a part-time capacity, means the team can also spot potentially complex medical or surgical conditions and fast-track a small number of urgent patients into hospital by avoiding much of the bureaucracy.

Dr Griffiths added: “There is a lot of job satisfaction working with patients to help them to get back to their normal activities or reducing their pain. I recently helped a patient who was struggling to play tennis because of a shoulder injury to return to the playing in their local club. It’s great to empower people and support them to make the necessary changes.”