A physiotherapist and orthopaedic surgeon are transforming the way patients with fractures are treated and saving the NHS more than half a million pounds in an initiative which could become a national model.
Physio Lucy Cassidy and consultant James Gibbs have established a virtual follow-up clinic for patients with simple fractures or soft tissue injuries. In the past these patients would have come through A&E and have to return for a follow up appointment at a consultant-led fracture clinic. But today these patients receive all their post A&E care online.
The patient’s x-ray and injury is assessed within 24 hours by a physiotherapist and an orthopaedic consultant to decide if they can self-manage their recovery remotely. Patients are then phoned by the physio and offered a virtual clinic referral.
Virtual clinic patients are emailed a video message from the consultant talking through the injury and the prognosis and a link to an individual rehabilitation video – one of 27 which have been produced – with a six-week exercise plan to follow. Patients can phone a specialist physiotherapist if they have any problems; the option to come into a traditional face-to-face consultant outpatient clinic remains open.
Cassidy, an extended scope practitioner says: “This is a no brainer – it works for the patient, it works for the consultants and physios and it’s cost-efficient. Patients absolutely love the virtual clinic they say ‘What, I don’t have to come in?’ They really appreciate the service and they have a safety net.”
Some 12,000 patients have been referred to the virtual clinic run by Brighton and Sussex University hospitals NHS trust since it began three years ago. Fifty seven per cent of those patients are discharged without ever having to return to hospital; 37% have a follow up appointment at a consultant out-patient clinic and 6% are seen by a specialist physio. The service has already saved the NHS around £500,000 as the cost of a virtual referral is £67 – half the price of a traditional clinic appointment. Those savings are expected to double in the next year because since May the service has expanded to include wrist and hand injuries which account for almost half of all fracture clinic referrals.
Under the virtual system patients who require a face-to-face appointment are now booked in with the most appropriate specialist consultant at an outpatient clinic. Cassidy explains: “Under the old system it was a bit of a lottery who you saw. The patient would come to the fracture clinic and if it was run by the shoulder consultant on that day, but you had broken your ankle, you would still be seen by the shoulder consultant. One of the complaints I get from the consultants now is that ‘all my clinics are now full with people that need to be seen.’ ”
Gibbs first had the idea of a virtual fracture clinic when he was a junior doctor: “I would sit in the fracture clinic and feel exasperated for me, and for the patients, because the majority of injuries you see heal on their own with the passage of time and we were seeing people in clinic unnecessarily.”
He admits his consultant colleagues were sceptical at first about the changes but there would be a “hue and cry” now if the trust reverted to the old system: “It’s standardised treatment for specific injuries, it’s freed up consultants’ time and we are working smarter.”
The virtual clinic – which is being showcased at the NHS Health and Care Innovation Expo 2016 in Manchester next month (September) – is already being adopted by others. Virtual clinics are now run at Western Sussex hospitals NHS foundation trust and Maidstone and Tonbridge Wells NHS trust in Kent; others in Hastings and Eastbourne are due to launch in January.
A free “plug and play” package – an electronic virtual clinic blue print – is available for trusts to use as a starting point. Computer software which will allow hospitals to run their own branded virtual clinic on their own system – to be sold under license – is due to be launched next February.
Cassidy and Gibbs believe the virtual clinic – which was recognised in the NHS Innovations Challenge awards this year – could become a national model. That ambition is shared by the Chartered Society of Physiotherapists. Society professional advisor Priya Dasoju says: “We would like to see this model rolled out but it’s key that it is a physio-led service because it’s physios who can provide the rehabilitation service. It’s such a simple concept but makes such a massive difference.”
Virtual fracture clinics are new to the UK but others already exist worldwide – particularly in rural areas of Scandinavia, according to orthopaedic surgeon Stephen Cannon, vice-president of the Royal College of Surgeons.
He says: “It does require resources in terms of time from the physio and the consultant and is a huge change for patients. But it is patient-centred, it works in other parts of the world – it’s a great idea.”
Health and Care Innovation Expo in Manchester on 7 and 8 September will explore the Five Year Forward View in action. High profile health leaders will speak across two stages, while feature zones will explore digital health, personalised medicine and new models of care. NHS colleagues can attend free-of-charge. Click here to register.
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Virtual fracture clinics enable patients to receive care online
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