Specialist led back pain service in primary care Royal Free London NHS Foundation Trust

GPs are under pressure due to a national shortage of GPs and a growing, ageing population. Research shows that dealing with musculoskeletal conditions takes 30% of GPs’ time.

This project piloted a first-contact advanced practice physiotherapist (APP) back pain service (BPS), in a GP practice with a population of 14,500. The APPs managed the whole patient pathway including investigations, diagnosing, prescribing, referral to secondary care and listing for spinal injections. The innovative aspect was the link between primary and secondary care provided by the APPs in the GP practice, and the ability to directly list patients for injections.

Impact of the project

The main impacts of the project, which saw 474 new patients, were:

• reduced secondary care referrals and investigations with cost savings of >£10,000 per 500 patients
• additional savings of £30 in primary care consultation costs per patient, per back pain episode
• reduced average wait time from initial consultation to injection (31 weeks to nine weeks)
• 80% of patients were seen once and discharged
• 100% of patients were extremely likely or likely to recommend the service to friends and family.

Enablers of the project

The main enablers of the project were:

• APP experience of managing back pain, and enthusiasm to ensure successful delivery
• linking primary and secondary care IT services to allow viewing of investigations and direct listing for spinal injections.

The main challenge was the difficulty in retrieving accurate data from the GPs practice’s databases, impacting on the reliability of the cost comparison. The team is optimistic that the BPS will be commissioned in the future and will continue to communicate its success. For now, the model of care will influence how new musculoskeletal physiotherapy services are delivered in Barnet and Enfield.

Contact

For further information about the project, please email Nicola Akehurst, Advanced Practice Physiotherapist Lead, Barnet Hospital.