Following on from our last chat on neuro rehabilitation, we have a chat looking wider at service provision in long term conditions with Ben Ellis on Monday 9th Nov at 8pm UK time (GMT).
Physiotherapists are an integral part of many long term condition (LTC) care pathways, for people with a range of neurological, rheumatological, respiratory and paediatric conditions. For many of these conditions successful management results in stable maintenance of pathology, impairment or function or even in some cases managed decline rather than a period of intervention resulting in an objective improvement. Patients expectations for access to services can be high and are frequently unmet. Some services use rationing of treatment sessions to manage stretched resources, such as offering blocks of 6 weeks of treatment, or a set number of sessions. Patients may be discharged following completion of a course of treatment or kept on open review. This can cause difficulties for services driven by referral and discharge data, but benefits patients who are at risk of being lost to follow up.
Pathway models for LTC services vary considerably. Physiotherapists may be based and managed within speciality focused services, for example within a community COPD team, or part of a separate physiotherapy service accessed by people from a number of different long term condition pathways, such as a neuro-outpatients department taking referrals for people with MS, PD, Stroke etc. Services can be based in hospitals, or in the community either as outpatients or within people’s homes. Some physiotherapy services have expanded organically to accept a widening range of conditions, whereas others may be commissioned specifically to cater to a defined patient group.
Do waiting lists and rationed services risk reinforcing the medicalisation of long term condition management placing the emphasis on waiting to see a physiotherapist rather than self-managing what is a life-long condition? Or does a focus on self-management risk missing the individual needs and variation between patients? The challenge for us as physiotherapists is how to best use our expertise and resources across the growing population of people with long term conditions to provide timely and effective care to the patients with the highest need.
Twitter is a fantastic forum for discussion and sharing ideas, and due to the range of service models and variety of approaches within different specialities this is a great opportunity for shared learning from the experiences of different clinical areas. So whatever your clinical background join us for a #Physiotalk chat to discuss service organisation and management approaches in long term conditions!
Pre chat resources
- Personalised care for long term conditions (NHS England)
- National service framework for long term conditions
Questions to consider before the chat
- What are your experiences of working within a long term condition pathway?
- Is it better for physios to be part of a patient pathway but based and managed separately or integrated within a specialist MDT? What works best of patients?
- Should long term condition services be hospital or community based?
- Should therapy sessions be rationed within a ltc service (ie; maximum 6 weeks input before discharge)
- Do you have any experience of using risk stratification to prioritise resource allocation?
- Does using terms like rehabilitation risk increasing expectations of recovery for patients?
Another fast and furious chat – so if you struggled to keep up you can find the transcript here
Ben Ellis @bendotellis is a Lecturer in Physiotherapy at Oxford Brookes University teaching on the BSc and Pre-registration MSc Physiotherapy programmes and Rehabilitation MSc. In addition he is currently working on a cross-sectional observational study of spasticity management in care home residents at the University of Nottingham. Ben has an MSc in Physiotherapy (Neurorehabilitation) from University of Nottingham and worked as team lead of a community neurological rehabilitation team in Walsall prior to moving into academia.