Community Physiotherapy Services
Nadine Jeal, Clinical Director: Adult Community Health Services, MSK Advance Practice Physiotherapist Whittington Health NHS.
- Physiotherapists in Islington work over a wide range of specialities. We recognise that it's much better for patients to be at home - it's much safer. Physio services are designed to support discharge rather than extended stays in hospital.
- Neuro rehab services are for patients who are recovering from a stroke or living with conditions such as Parkinson's. It would be great to see more investment in this area as it has huge potential to increase people's function.
- You may be frustrated with access to physiotherapy at the moment. Lots of NHS staff were redeployed during Covid surges. Professionals working in community health services at the Whittington were redeployed to urgent care on 3 occasions. Now there are longer waiting times and more complex cases because people didn't get as much of the help they needed during the pandemic. We also have challenges with staff leaving the NHS and increasing abuse/racism/aggression towards staff.
- The Whittington Health website hosts a lot of self-help resources
First Contact Physiotherapists
Dr. Helena Lendrum, GP Fellow, Islington GP Federation
- First Contact Physiotherapists (FCPs) are being introduced into GP surgeries. These staff are seeing patients with bone, joint, or muscle problems without the need for GP referral.
- FCP appointments are 20 minutes long (twice as long as a GP appointment) but you don't then get provided with a course of physio, rather it's an early intervention. For example, you fall over at work and twist your knee. Perhaps you've read the Whittington Health self-help information and you've had ice on your knee, but it's not getting any better. Instead of seeing the GP, you see the FCP. You don't have to see the GP first so you have a shorter wait and more time for your appointment. FCPs can still order tests, refer you to the Whittington, prescribe painkillers, and provide certificates for time off work. It also has a preventative function if you get high quality advice or intervention early on.
- At the moment there are 2 First Contact Physiotherapists in the borough. Both are working in North Islington. They work out of GP practices for half a week and deliver hospital-based physio for the Whittington for the rest of the week. It's a new programme so we need to prove that it works before expanding the rollout.
How soon till we get FCPs in the south of the borough? They sound like a really good idea.
Hopefully, in the next 12 months FCPs will be rolled out all over the north of the borough. The Primary Care Network in the south of the borough is really early on in its process with regards to FCPs. However, everyone is really keen on this scheme. Clinicians and Whittington Health really want it. There are challenges in recruiting sufficient numbers of specialist staff. There's a shortage of physio staff at the Whittington so rolling out more is a real challenge.
Just to add to this, NHS England didn't include enough money for us to be able to employ staff initially. By the time we found out that we could pay London Waiting we were six months behind other areas. Getting physio staff is like gold dust but we've got lots of initiatives to try and attract band 7 (top) physio staff. They can earn more in private practice.
Are the FCPs only seeing patients for problems arising from injury or do they also treat chronic conditions like arthritis?
Yes, they see both. They provide first contact about the issue so it can be a real benefit for those with chronic conditions.
By going directly to booking online (self-referral) do you bypass having to be triaged by a GP?
Yes, absolutely it doesn’t need to go via the GP. One of the strengths of this scheme is that it takes pressure off GPs. However, if your needs are complex it may be worth having a conversation with your GP as well.
Yes the whole point of FCP is that it saves GP time. You will be asked a short set of questions over the phone by the GP receptionist (checking that you are over 18 and need physio for joints rather than respiratory conditions, for example).
Is space in GP surgeries costed?
Workforce is a bigger issue than space. In the north, half of the practices have physical space for an FCP and half don’t so practices may end up sharing FCPs.
Is this a scheme that allows the government to outsource NHS services to private providers?
Yes, that is a risk. One of the Primary Care Networks in Haringey has taken private providers on. That can mean there’s less integration with NHS services. In Islington we did receive offers from private providers but we were very keen to work with the NHS providers like the Whittington.
There may be a role for private providers if the NHS cannot deliver a service on its own but they would never be the first choice.
Would this delay urgent treatment? I tried the self-referral process and there was a three month waiting list. I also had difficulties contacting my GP.
I’m very sorry that you have had a bad experience. We can pick that up outside of this meeting. Because of the pandemic, there have been workforce challenges and the waiting list is much longer than we would like it to be. Every self-referral is looked at by a senior clinician and triaged to either routine or urgent. A conversation with your GP can be helpful particularly if your case is complex and it may be better for them to complete the referral. (That wasn’t easy in this case) During the pandemic, a lot of consultations took place over the phone. Now all first appointments are face to face which is so much better. Physiotherapy for Neuro/Falls/MSK (Musculoskeletal services) is very difficult to do over the phone.
When you’re waiting you can talk to your GP. That’s part of what General Practice is about. Your GP can’t provide that specialist care but can tweak things in the meantime while you’re waiting for secondary care.
I’ve had physio in Islington. It’s always been wonderful. Physios are worth their weight in gold. Please keep them in the system.
Thank you that’s nice to hear. One thing I’d say is that it’s very important to do the exercises that your physio sets you. Exercise is the best drug we have. It’s always the key solution, so do what your physio says. Treat it in the same way as cleaning your teeth – it’s something that you should never stop because it’s so important for every aspect of your health.
If I’m able to afford private physio should I have it and what are the good private providers?
If you have the money then why not. There are lots of really excellent private providers but what you can’t tell is if you have booked one of those. We can’t make individual recommendations. In the NHS there’s more consistency and all our staff are well supported and trained. What you might want to do is dip your toe in the water. Don’t continue with something if you feel it’s not helping. Regardless of whether you’re accessing an NHS or a private service you should always feel listened to.
I’ve had experiences where I’ve left messages but not been called back
We can pick that up outside of this meeting. There might be something wrong with the mailbox.
Thank you. I’ve had similar experiences at the UCLH where I’ve left messages for the consultant and they haven’t seen them.
Talking about the value of exercise, is reduced gym membership for older folks still ongoing?
No, that particular scheme has ended due to a combination of funding issues and Covid forcing gyms to close. There is something similar that is available for the weight management service but the eligibility criteria for that service are different. We’ve all suffered a bit from the lack of gym and exercise facilities during the pandemic. Regular exercise is also great for mental health.
Islington Social Services have offered paid gym membership for services supporting mental health
Even without discounted membership, the gym is cheap for older residents. You pay £5.50 a year plus £2.50 per session to use the gym. That’s quite affordable. That’s with Better gyms.
Age UK also offer discounted sessions at the Sobell Centre. £2.10 for the whole morning.
Healthy Generations makes lots of exercise available online or in person.
Thanks to you all for the information about the schemes that are available in the community. As a health provider, it’s hard to keep up to date with all this information. Social Prescribers based at GP surgeries tend to have this information.