"Physiotherapy outpatient services "

About: Bodmin Community Hospital Devon, Cornwall and Isles of Scilly Newquay Hospital / Physiotherapy

(as the patient),

A new out patient system has been put in place resulting I think in a deterioration of the booking service. 3 years ago I suffered a loss of movement in my neck due to a back problem. This was effectively treated by the excellent staff at Bodmin hospital. A year after that this problem started to recur so I used the outpatient service at Newquay hospital as there was less demand there than at Bodmin and again I received excellent treatment over several weeks. After 2 trouble free years I am again experiencing problems and so contacted Newquay to check the drop in out patient service was still available - I was told that from that very day the service was no longer drop in but required a doctor's referral.

There was some confusion about this at my doctors surgery due to the new measure not being well understood and it is now a week later and I am waiting for the referral letter and for an appointment to be booked, meanwhile my health gets worse. While a few days delay are due to misunderstanding, this new requirement seems ridiculous and all of the health professions I spoke to during this process have criticised the new procedure.

I understand it is to reduce unnecessary demand on the physiotherapy service but how can a requirement for patients to make a GP appointment, wait for a referral letter to get a booking over several days help reduce the workload on the NHS? There is extra work for the GP, GP secretary staff and needless delay in treatment which will surely mean the eventual treatment required is going to be longer and cause extra suffering on the patient.

The drop in physiotherapy was excellent and the morning drop in sessions were followed up by later afternoon appointments if more treatment was needed and this was judged by qualified physiotherapist rather than the GP which is surely better.

If there is a demand for physiotherapy services why not increase those rather than try to reduce demand by putting pressure on other parts of the health service which are already overworked. The health professionals at both Bodmin and Newquay all gave excellent services but the management of the service needs to be looked at carefully and priorities set.

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Response from NHS Kernow CCG

Like all NHS commissioning bodies, NHS Kernow is facing many pressures upon its resources. In the case of the self-referral Musculoskeletal service (MSK), demand has been rising in an unmanaged way that risked the future viability of the service.

The introduction of the need for a GP referral provides clinical oversight to ensure that the people referred to the service are those for whom it is most clinically suitable ie individuals with moderate lower back & neck pain of less than 12 months in duration.

Dr Rob White, clinical lead for NHS Kernow has said: ‘To ensure that we protect vital services during increasingly financially challenging times, some important clinically-led choices have to be taken to protect services. We do not believe that un-triaged entry into the self-referral Musculoskeletal services is the making the most effective use of resources. The move to provide triage into the service means that self-limiting conditions can be excluded. We understand that this may be inconvenient to those wanting to self-refer with appropriate MSK conditions, but by excluding self-limiting conditions we should provide better access and reduce pressure on the providers. These decisions have not been taken lightly, having been tested with clinically led forums and ratified and supported. Clinically led decisions such as these are about ensuring high quality, evidence based services are protected rather than lost.’

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Update posted by Denzill (the patient)

I agree that triage is important to determine the best use of resources and my original comment was a criticism of the means of triage put in place which seems to put pressure on another part of the health service which is not a useful way of tacking the problem. The response contains statements which are not backed up by evidence - what are the figures involves for patient treatment, what is the opinion of the health professionals offering the service, can we have some statistic please to see how the service is operating so we can make up our own minds on this. Was there a period of analysis to see just how many of the self referrals were unnecessary before the new system was put in place? If so then can we see the statistics please and if not then why not.

If a service is receiving a lot of demand them maybe it is because it is needed and in that case restricting availability will only result in more serious health problems in the long run which will be an even greater drain on public resources.

What does 'The move to provide triage into the service means that self-limiting conditions can be excluded' mean? What is a self-limiting condition? Please give more information about 'These decisions have not been taken lightly, having been tested with clinically led forums and ratified and supported'.

Can you offer an evaluation of the working hours and costs involved if the self referral system was continued and those we have now with GP and local practice secretary services required and can you provide any feedback from those health professionals actually providing the services to support your answer?