Millions to get fast support to overcome back pain thanks to NHS Long Term Plan

Tens of thousands of people have been helped to overcome back pain, arthritis and other muscle, bone and joint conditions without going to hospital, thanks to additional specialist care at local GP surgeries – with millions more set to benefit over the coming years as the NHS delivers on its Long Term Plan.

Trials in 41 areas including Nottingham, West Cheshire and Gloucestershire have seen patients choosing to be assessed and treated for common musculoskeletal conditions by physiotherapists with enhanced skills based in GP practices, rather than waiting to see a GP to get a referral to hospital.

Evaluation of the service found that in some areas they delivered hundreds of thousands of pounds of savings which the NHS can reinvest into patient care, while patient satisfaction with the care they received was very high – in some cases 100%.

And new polling today shows that people are overwhelmingly in favour of this approach, saying that they would be happy to see a physiotherapist as the first point of contact instead of a GP if they have back or joint complaints.

The service will be rolled out to help patients across the country as part of the NHS Long Term Plan which is expanding services at GP surgeries, with primary care networks joining up care across every community.

Patients will be able to book convenient appointments directly with physios and other expert health professionals at a local practice, without the need to wait for a referral or travel to a specialist clinic, which might be out of town.

Initial findings from the pilots, supported by NHS England’s Elective Care Transformation Programme, show that faster treatment leads to faster recovery. Up to seven in 10 patients were successfully discharged after just one consultation, and one part of the country reduced the number of people requiring long term physiotherapy care by a fifth. The service also helps people to manage their arthritis.

Allowing patients more direct access to the specialist care they need is better for people’s health, but also reduces pressure on GPs’ time, with one practice freeing up an extra 560 appointments over the course of a year.

The NHS Long Term Plan set out an ambition to reduce the number of hospital appointments by 30%, saving thousands of journeys, reducing traffic and pollution, and making the NHS more efficient. This aim will be supported by a review of how the NHS measures waiting times for non-urgent care.

Professor Stephen Powis, NHS medical director, said: “More physios based in community GP surgeries means people have more choice and can get the treatment they need without waiting weeks to make what can be a long journey to hospital for a short appointment, and is a great example of how the NHS Long Term Plan will increasingly deliver more care options closer to home over the coming years.

“Achieving this improvement and crucially, giving patients more options will also have an impact on how we currently measure waiting times for care, which is why we are working with clinicians and NHS leaders to design and test new systems, which better reflect modern care and patients’ needs and outcomes.”

In a poll of 2,005 UK adults conducted by Opinium on behalf of the Chartered Society of Physiotherapy, nearly three-quarters (73%) said they would take an appointment with a first contact physiotherapist if they were offered one when seeking help for a bone, joint or muscle problem, with fewer than one in ten saying they would decline.

Professor Karen Middleton, Chief Executive of the Chartered Society of Physiotherapy, said: “The most important thing for patients is to see the right person at the right time and placing physiotherapists in GP surgeries allows them to do just that.

“It speeds up access to the expertise they need, while reducing the likelihood of them having to attend further unnecessary appointments or undergoing tests they don’t require.

“It’s working already in a number of places across the country and the patient satisfaction results from those services speaks volumes about the public support for seeing a first contact physiotherapist.

“The expansion of this role is great news for patients and symbolic of the transformation needed for the NHS to continue to deliver high quality care where it’s needed most.”

More than 100 million hospital appointments take place in England each year, around double the number a decade ago, with referrals for treatment rising by around 4% each year.

The Elective Care Transformation Programme is part of an effort across the health service to ensure patients see the right person in the right place, first time, speeding up their treatment and recovery, and reducing demand for hospital services.

The programme, introduced in March 2017, has seen the number of referrals by GPs to surgery and other planned treatments fall by 4%.

Some of the successes from the areas trialling the greater use of first contact practitioners in GP surgeries included:

  • In West Cheshire, a GP physiotherapy service achieved a 20% reduction in referrals to hospital after five years of an annual 12% increase, resulting in shorter waiting times and savings in the region of £650,000. Six out of ten patients were discharged after the first appointment, and 99% of patients rated the service as good or excellent and were happy to use it again.
  • In Darlington, a First Contact Practitioner service in four GP surgeries helped 1,147 patients, only 2% of whom needed to see the GP. Three quarters of patients were supported to manage their condition without the need for further appointments, and 100% of patients said they would recommend and use the service again.
  • In Nottingham a 12-month pilot in two GP practices saw 555 patients receive care from physios – seven in ten of whom required no more treatment after their first or second appointment, with only 2% needing to see their GP.

Building on the early success of these and other physiotherapy pilots, the NHS in England will ramp up the use of first contact physiotherapists in GP surgeries, with around half of patients in need of physio set to get faster treatment.

This will be supported by the £4.5 billion worth of extra investment which will be spent on primary medical and community services every year by 2023/24, announced in the NHS Long Term Plan on January 7, and the new GP contract, which will see primary care teams bolstered with an extra 20,000 professionals to provide greater access to care for patients. This will be extra funding, through a new primary care network contract, to support teams with the costs of employing a variety of different specialists, with a particular focus on pharmacists and social prescribing link workers in 2019/20, and later expanding to physiotherapists, physician associates and paramedics.

The NHS is also undertaking a clinically-led review of how current measures – including the 18 week standard for non-urgent operations and other treatment – could be improved to ensure they measure what matters most to patients, reflect significant advances in how services are delivered, and support NHS staff to deliver the best quality care possible.

The review, being conducted by top clinicians and hospital bosses, is expected to present recommendations for trials in Spring, which if successful will be adopted fully in time for next winter.