Musculoskeletal disorders are common and account for between 15-20% of all GP consultations. Like many areas in the UK the Isle of Man has an ageing population, but it also suffers from healthcare professional recruitment problems – there is a notable shortage of physiotherapists. Being a small island with a population of 80,000 also makes provision of services a challenge. This culminated last year in a contraction of the physiotherapy service, with treatment only offered to patients with acute conditions.
Local GPs, though understanding of the problems, felt that lack of physiotherapy services for patients with musculoskeletal problems would drive up prescribing and referrals to secondary care and sought help from a third party.
What we did
Stephanie Maddrell, who leads musculoskeletal outpatient physiotherapy services for the island, undertook extensive research on self-referral models in the UK and abroad. There is a wealth of evidence that prompt referral for physiotherapy assessment and intervention not only shortens illness, disability and time off work, but also reduces prescribing and referrals to secondary care. A recent American study showed that urgent physiotherapy treatment for patients with low back pain halved the chances of that patient having to undergo surgery or steroid injections.
After extensive consultation with the island’s 40 GPs, a self-referral scheme was introduced in April. Patients with acute musculoskeletal conditions – defined as a condition of less than eight weeks duration – can complete a referral form themselves and are then asked to telephone the physiotherapy department two days after the form should have been received. The patient is then offered a same-day appointment where possible, or something the next day or the day after. Forms are available from the island’s four physiotherapy departments, Nobles Hospital reception, all GP practices and high-street pharmacies and are also available to download from the island Government’s website.
The scheme has been publicised in the local press and championed by GPs and their receptionists. Despite initial concerns that demand might overwhelm the existing services, the scheme has enabled prompt and early treatment of acute musculoskeletal complaints, reducing the number of follow-up visits and GP consultations. Passing responsibility to the patient to arrange an appointment has enabled early access and driven down do-no-attend rates.
On discharge from the physiotherapy service, the GP receives a summary letter regarding their patient. If a second opinion or further investigation is warranted, there is a direct route for the patient to be referred by their physiotherapist for an orthopaedic opinion and/or MRI and X-ray through Nobles Hospital. Patients who present through self-referral with suspected rheumatoid arthritis, benign congenital hypermobility syndrome, ankylosing spondylitis or psoriatic arthritis that has not yet been diagnosed will be referred directly to the island’s consultant rheumatologist.
GPs on the Isle of Man have welcomed the new service and still retain the ability to refer patients directly. In July, the scheme will be expanded to include more chronic conditions. It is hoped that increased access to physiotherapy assessment, the establishment of home-exercise plans supported by cognitive behavioural therapy approaches will improve the treatment of musculoskeletal conditions, encourage early mobilisation and decrease the dependence on prescriptions for analgesia and secondary referrals.
The scheme is presently being audited and initial results are very promising. It is hoped that such services will prove successful on the Isle of Man and ensure its symbol of a three-legged man remains healthy and mobile.
Dr Alex Allinson is a GP in Ramsey on the Isle of Man