An Evaluation of the Impact of Primary Care Musculoskeletal (MSK) Physiotherapy Transformation Projects across Scotland.

Problem

In 2017 the Scottish Government, through the Scottish School of Primary Care, requested an evaluation of the transformation of primary care musculoskeletal (MSK) physiotherapy delivery across Scotland. New models of service delivery were intended to impact GP workload and the high level of physiotherapy referrals into secondary care. We aimed to:1. Understand the context in which the new models of MSK physiotherapy provision are being tested 2. Identify the MSK physiotherapy projects being funded across Scotland and the key stakeholders at project and Health Board level. 3. Identify the broad aims, target population, activities, proposed impacts and projected timelines of MSK primary care transformation projects.4. Identify key sites for further in-depth study in Phase 2 of the evaluation.

Approach

Phase 1 involves the evaluation of new models of MSK physiotherapy delivery in primary care within all Scottish Health Boards, narrowing to a smaller number of case studies in Phase 2 for in-depth evaluation. Phase 1 involved a review of 73 national and local documents describing the projects alongside in-depth semi-structured qualitative interviews with 18 key respondents.

Findings

Phase 1 identified two main tests of change rolled out across Scottish Health Boards: Advanced Physiotherapy Practitioners (APPs) (implemented in 12/14 Health boards) and the use of NHS24 Musculoskeletal Advice and Triage Service (MATS) (implemented in 10/14 Health Boards). APPs act as a first point of contact, allowing patients direct access to physiotherapy services. Interviewees reported that APPs helped reduce GP workload and referrals to secondary care, and improved patient experience. Barriers to the sustainability and spread of the APP role included continued funding, training, recruitment and retention of staff. MATS is a telephone service operated by NHS 24 which triages callers, referring them to physiotherapy services or providing self-help guidance. MATS was reported to be cost effective, with funding being top-sliced from each Health Board’s existing budget, saving NHS Scotland over 10,000 allied health professional MSK service referrals/year. Barriers to its impact included funding and lack of overall national buy-in due to some Health Boards not joining the MATS service.

Consequences

We provide here an overview of the new models of care being deployed Scotland-wide, identifying key implementation barriers and facilitators of new methodological approaches to primary care MSK physiotherapy access. These results are relevant to those involved in designing, implementing or evaluating new models of MSK physiotherapy delivery in a changing primary care environment. MSK physiotherapy redesign is expected to ensure patients see the correct healthcare professional at the correct time, with the potential to impact positively on GP workload and a 4 week physiotherapy waiting target. Further in-depth evaluation will establish logic models for the deployment of MSK physiotherapy services in primary care across Scotland.