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Background
Medical evidence shows that early physiotherapy intervention on musculoskeletal injuries can prevent acute conditions becoming chronic and promote swifter recovery, return to the workplace and improved productivity levels.
Looking for a solution to help its employees recover more quickly and safely from musculoskeletal injuries and conditions that required treatment, Cheshire and Wirral Partnership NHS Foundation Trust turned to Physio Med to provide a robust, blended physiotherapy service.
Brief
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) employs circa 3,500 staff across 65 sites, providing mental health, substance misuse, learning disability and community physical health services across Cheshire and Wirral, plus some specialist services in Liverpool, Sefton, Bolton, Warrington, Halton and Trafford. The Trust serves a population of approximately one million people.
The nature of the services provided by the Trust mean that many of the job roles are physically demanding, with nursing and healthcare workers particularly prone to suffering from musculoskeletal disorders (MSDs) as a result of, or exacerbated by, moving and handling tasks.
This was putting the Trust’s in-house physiotherapy service under increased demand, resulting in staff suffering from musculoskeletal disorders having to wait for an appointment. This in turn was leading to employees being absent from work or working at reduced levels of productivity.
So the Trust decided it needed to find a way to support its employees in accessing quality physiotherapy treatment much more quickly in order to:
- Reduce MSD-related employee discomfort and pain levels
- Minimise associated absence and facilitate an early return to work
- Improve productivity
- Reduce the risk of further absence due to recurrence of MSD
Solution
After a successful trial, the Trust tasked Physio Med with implementing a blended model of physiotherapy service which provides fast-track access to treatment in order to support staff health and wellbeing, improve productivity and reduce sickness absence.
Employees who suffer a musculoskeletal injury or disorder are referred to Physio Med by either their line manager or the occupational health department. The employee is then contacted by Physio Med’s team for a telephone triage, within as little as two hours and a maximum of four, to ensure they are appropriate for treatment.
All appropriate referrals then receive an initial assessment within two days, with acute conditions going through Physio Med’s award winning Physiotherapy Advice Line (PAL) service and chronic injuries being referred directly to the face-to-face (F2F) service via Physio Med’s network of clinics.
The PAL initial assessments are carried out over the phone by a Senior Chartered Physiotherapist and incorporate a series of evidence-based clinical questions and a series of movements to facilitate diagnosis. The employee is then advised on the best way to self-manage the condition, thereby assisting the physical healing process. This includes:
- Appropriate advice regarding their work station, lifestyle, medication, posture and methods of symptomatic relief
- Realistic advice on modifying the working day to accommodate the injury
- An individually tailored progressive exercise programme created by the physiotherapist to speed up healing, communicated via comprehensive video exercise files, and accessed via a computer, smartphone or tablet.
Employees referred directly for F2F treatment receive an appointment, usually within two days, at one of 780 hand-picked practices across the Physio Med UK network.
Outcome
In order for staff to be able to look after their patients and carry out their duties to a very high standard, they need to be at work and in excellent physical health themselves. Therefore, reducing the levels of sickness absence due to MSDs was a key driver for the Trust.
In a 21 month period, from April 2015 to December 2016, a total of 520 cases were progressed by Physio Med, with 54% being treated via the PAL service and 46% with chronic conditions being routed directly for face-to-face treatment.
At the point of referral, 21% of the employees referred were absent from work due to injury, while the remainder were at work with pain and therefore operating at reduced productivity levels and highlighting the hidden cost of presenteeism.
A total of 64% of patients on the PAL service were discharged after just ten days, as their condition had either resolved or they were able to effectively self-manage it. Employees discharged from the F2F service received an average of just over five sessions each, including the initial assessment.
Of the 520 appropriate referrals, only 18 remained off work and there was a reported pain reduction of more than 60% amongst those who returned to work.
In financial terms, and based on the average daily cost of a Trust employee being £131.81*, the service has delivered significant returns.
The improved productivity and function multiplied by the days saved in not waiting to access NHS treatment delivered a total estimated saving of £1.44million over the 21 month period – which equates to an ROI figure of 17:1
This played an important role in Cheshire and Wirral Partnership NHS Foundation Trust maintaining its service levels to the general public, meeting NHS targets and, of course, saving the Trust money.
Karen Phillips, Head of Workforce Wellbeing at the Trust, said: “As a frontline service we need all of our staff to be fit enough to carry out their roles. From healthcare and nursing staff that can face quite physically demanding situations, to estates and domestic teams, and even admin staff, they are all at risk of suffering MSDs and we need to help them back to full fitness as quickly as possible to enable us to provide services to patients.
“We benchmarked our in-house provision against Physio Med’s PAL service and the initial results have been really positive. 79 per cent of those who report an MSD are still in work when they are referred which can have a huge effect on productivity so being able to give them timely access to treatment and helping them return quickly to full fitness is a huge benefit to the Trust.”
Other outcomes included:
- 96.5% of those referred were retained at or had returned to work at the point of discharge
- 84% of those off sick at the point of referral returned to work
- 35% (51% to 86%) improvement in productivity and function - equating to 1.75 days per person per week working a five day week
- Average time to access Physio Med service of 1.3 days v average time to access NHS physiotherapy of 71.5 working days
* Reported by the Trust’s OH department in January 2017
