AHP activities in Scottish MSK services A scoping study for NHSScotland Sue Parroy Summer 2005 WORK IN PROGRESS AHP activities in Scottish MSK services Contents NHS Argyll and Clyde 3 NHS Ayrshire and Arran 6 NHS Borders 8 NHS Dumfries and Galloway 9 NHS Fife 10 NHS Forth Valley 13 NHS Grampian 16 NHS Greater Glasgow 22 NHS Highland 26 NHS Lanarkshire 28 NHS Lothian 32 NHS Orkney 37 NHS Shetland 37 NHS Tayside 38 NHS Western Isles 42 2 WORK IN PROGRESS NHS Argyll & Clyde AHP activities in Scottish MSK services NHS Argyll & Clyde The geography of Argyll & Clyde is some of the most diverse in Scotland and presents particular challenges. There is a population of around 418750 K. Four out of five people live in the areas of Paisley and Renfrew, Greenock and Port Glasgow, Dumbarton and Helensburgh and other towns. The remaining population live in remote and rural communities, including 26 inhabited islands of which only three (Islay, Mull and Bute) have populations over 1000. Primary Care Direct Access to Physiotherapy – available at four Health Centres in Renfrewshire. [email protected] Podiatry clinics that have been set up to ease access for patients are varied including: Drop­in, direct access, emergency and nail care. A social nail care programme to be piloted in the north will have MSK input. sharon.lafferty@renver­pct.scot.nhs.uk Podiatry Biomechanical Service. Patients can self refer or may be referred by their GP, Consultant or other healthcare professional to this community based service. Alan.Best@renver­pct.scot.nhs.uk Joint working with orthotist, physio and podiatry. Biomechanic (0.5wte) based at Dumbarton [email protected] Acute care Royal Alexandra Hospital Musculoskeletal physiotherapy services [email protected] • Direct Access (self­referral), Hydrotherapy, • A Hand Clinic • Accident Emergency / Fracture Clinic, with a Senior I input who does injection therapy • Acute Low Back Pain Clinic (service has links with Diagnostic/Imaging dept, orthopaedics,Neurosurgeon and pain clinic) • Physio/Nurse led joint replacement review clinics – pilot study for 1 year • Extended Scope Physiotherapy sessions for orthopaedic knee and hand referrals • Audits have demonstrated that a trained ESP can independently manage appropriately vetted orthopaedic referrals. Podiatry Consultants and Specialist Nursing Staff may refer to the Specialist Podiatrist within acute sector for multi­disciplinary working with Orthopaedist and onward referral to community based Podiatry Biomechanical Service. 3 WORK IN PROGRESS NHS Argyll & Clyde AHP activities in Scottish MSK services Occupational therapy Staff are involved in • The Multi Agency Team for Care at Home (MATCH) team in assessments within A&E and facilitating supported discharges to prevent avoidable admission. • Pre­admission elective surgery clinics – assessments for patients awaiting elective admission for joint replacement. • Following assessment by the Occupational Therapist the Technical Instructor continues the rehabilitation process at home and therefore manage their own caseload with supervision. Vale of Leven Hospital Joint replacement surgery Patients are contacted by the Occupational Therapist as soon as their name is put on the waiting list for joint replacement. OT intervention/Home Visit offered. This allows access to the service prior to the pre­surgery assessment clinic. Inverclyde Royal Hospital, Greenock Physiotherapy. Very much part of the local community, with clear patient information leaflets. Physiotherapy outpatient services are based around the acute hospital and three peripheral health centres and one other small clinic. Weekly meetings allow staff to jointly manage referrals across the patch. Jenny.irons@ Orthopaedic sessions – There are three ESP sessions (clinics) per month: two spinal and one knee. The consultant currently triages the waiting list and allocates the referrals to ESP or consultant. Due to staffing constraints this has been found to be more time efficient than the previously tried ESP physiotherapy triage; access to diagnostics still has to be established. A domiciliary and orthopaedic team with a falls project in its infancy. Other services Multi­disciplinary Health Education Groups for Rheumatoid and Osteo­ arthritic patients delivered by Alan.Best@renver­pct.scot.nhs.uk Rheumatology services within the medical team with nurse lead clinics offering injections. The physiotherapist works closely with these clinics. An interactive exercise scheme co­ordinated by the council in Greenock: which any health professional can refer into. Patients take the referral to the leisure centre of their choice. Developments ESP Podiatrist to be part of multidisciplinary Orthopaedic Outpatient Redesign (CCI supported). This project will examine a triage system for orthopaedic referrals, with Podiatry managing the identified foot and lower limb referrals in partnership with orthopaedic consultant staff. ESP Podiatrist will undertake part of the Orthopaedic Outpatient Redesign process within a primary care setting to enable a proportion of the patient journeys to remain within the community rather than be acute based. 4 WORK IN PROGRESS NHS Argyll & Clyde AHP activities in Scottish MSK services Development of Podiatry supported self–help educational groups allowing patients a role to play in their own health management. Temporary funding obtained from Community Outpatient Services to expand Acute Low Back Pain clinics into the Health Centres. Temporary funding obtained from Centre of Change and Innovation to increase Extended Scope Practitioner sessions in Orthopaedic clinic. The intention is to see patients referred with lumbo­sacral problems. Lottery funding has been obtained to pilot an Occupational Health Physiotherapy service across Argyll & Clyde. Inverclyde Royal Hospital, Greenock Pain Clinic – physiotherapy input to a pain clinic, with access to a clinical psychologist and a pain management programme. Injection clinics – Physiotherapy led clinics in one of the health centres. Electronic referral protocols on the hospital “sky” system and in the future electronic physiotherapy referral. Self­referral to physiotherapy will be considered when the results of the national trial are published. 5 WORK IN PROGRESS NHS Ayrshire & Arran AHP activities in Scottish MSK services NHS Ayrshire & Arran NHS Ayrshire & Arran provides a range of care to around 367,000 people. It is home to 7.2% of all Scotland’s population. There is a wide mix of urban and rural areas. AHP services are managed individually across the board, although there is a move toward single system working. All the physiotherapy staff are employed by the General Hospitals division with some staff working in primary care facilities. Most of the physiotherapy staff involved in musculoskeletal services are employed by the General Hospitals Division with some staff working in primary care facilities. [email protected] There are some staff in the Community care division who also see patients with musculoskeletal conditions. [email protected] Physiotherapy Direct Access Introduction of direct access via self­referral at Brooksby Out­ Patient Clinic in Largs as part of a Glasgow Caledonian University one year study. [email protected] Orthopaedic Clinics There are 7 Orthopaedic Consultants at Crosshouse Hospital and 5 at The Ayr Hospital. • Two Physiotherapy Extended Scope Practitioners work in the orthopaedic clinics. One working at Crosshouse Hospital 5 sessions per week and the other working at Ayr Hospital 4 sessions per week. [email protected] • One Physiotherapist treats patients in the Physiotherapy Department of Crosshouse Hospital for injection therapy. [email protected] Falls Classes in Ayrshire to identify musculoskeletal neuromuscular problems and coping strategies with patients who are at risk of falls or who have already fallen. [email protected] Hydrotherapy in Crosshouse Hospital and restricted access to Hydrotherapy at Arroll Park, Ayr. Contact Susan Middleton in Physiotherapy in Crosshouse Hospital. A Physiotherapy Orthopaedic outreach service is provided to patients discharged from the orthopaedic wards of Crosshouse Hospital to facilitate prompt discharge. [email protected] Early supported discharge, for patients with fractured neck of femur, is provided by Physiotherapy from the Orthopaedic ward at Ayr Hospital. [email protected] 6 WORK IN PROGRESS NHS Ayrshire & Arran AHP activities in Scottish MSK services A service is provided for ante and post natal women with pelvic and/or low back pain. [email protected] A programme is provided for patients with chronic pain in Ayrshire Central Hospital. [email protected] Rheumatology Two senior Rheumatology physiotherapists work in out­ patients and clinics at Crosshouse and Ayr Hospitals. There is input to the rheumatology wards and Multi­Disciplinary rheumatology education sessions for patients and relatives. There is a ‘One Stop’ Multi­disciplinary Inflammatory Joint Disease Clinic for patients, held in Heathfield Clinic and Ayrshire Central Hospital. [email protected] Podiatry Podiatry service, reconfigured in 2003, is now needs, rather than demand led. Patients can self­refer to podiatry and they will be given a care programme. Healthcare professionals Ayrshire­wide can refer to Podiatry, but there is no dedicated MSK podiatry service or any podiatrists