Background
The Sheffield Health and Social Care NHS Foundation Trust (SHSC) provides a wide range of specialist health and social care services to improve the mental, physical and social wellbeing of Sheffield’s residents.
Dedicated to improving people’s health and wellbeing, meeting their social care needs and supporting their recovery to full fitness, the SHSC provides a range of services, including drug and alcohol misuse services, mental health services and rehabilitation services, as well as primary care services delivered through five GP practices across Sheffield. SHSC employees also provide residential services for individuals who cannot be appropriately helped within their community and regularly carry out home visits.
Although the SHSC offered its staff access to the Workplace Wellbeing NHS Service to safeguard their wellbeing, the service did not include a physiotherapy provision.
Brief
The SHSC employs more than 2,400 staff. With many roles at the SHSC being physically demanding, it was vitally important to the Trust to ensure musculoskeletal disorders didn’t cause an increase in sickness absence rates, reduce productivity or prevent its employees from carrying out their job of looking after the public.
However, with access to NHS physiotherapy via GP referral taking up to 14 weeks*, employees suffering from MSDs were often absent from work for extended periods or working at reduced levels of productivity while waiting to access treatment. As a result, the SHSC wanted to offer staff members fast-track access to a physiotherapy provision to ensure they could receive treatment quickly, in accordance with medical evidence which suggests that the best way to prevent acute musculoskeletal conditions becoming chronic is through early physiotherapy intervention.
The Trust decided it needed to find a way to support its employees in quickly accessing quality physiotherapy treatment in order to:
- Reduce MSD-related employee discomfort and pain levels, and the risk of further absence due to the recurrence of MSDs
- Improve productivity
- Minimise associated absence, and
- Facilitate an early return to work
Solution
In April 2018, the SHSC appointed occupational physiotherapy provider Physio Med to implement a blended model of physiotherapy services which provides fast-track access to treatment.
Employees suffering a musculoskeletal injury or disorder are first referred to Physio Med by the Trust’s HR department and then contacted by a member of the Physio Med team for a telephone triage, within as little as two hours and a maximum of four, to ensure they are appropriate for treatment.
All appropriate referrals then receive an initial assessment within a maximum of three days, with acute conditions going through Physio Med’s award-winning Physiotherapy Advice Line (PAL) service and chronic injuries being referred directly to the face-to-face (F2F) service via Physio Med’s network of clinics.
The PAL initial assessments - which comprise a series of movements and evidence-based clinical questions designed to facilitate diagnosis – are then carried out over the phone by a Senior Chartered Physiotherapist, enabling the employee to be advised on the best way to self-manage the condition and assist the physical healing process. This includes:
- A bespoke progressive exercise programme created by the physiotherapist to speed up healing, communicated via comprehensive videoexercise files, and accessed via a computer, smartphone or tablet
- Appropriate advice regarding their workstation, lifestyle, medication, posture and methods of symptomatic relief
- Realistic advice on modifying the working day to accommodate the injury.
Employees referred directly for F2F treatment receive an appointment within an average of 2.6 days at one of Physio Med’s network of 780 hand-picked practices. With several practices to choose between, employees are also able to select the one most convenient for them.
Outcome
In the 12-month period to April 2019, a total of 175 appropriate referrals were progressed by Physio Med, with 53.7% being treated via the PAL service and 42.8% with chronic conditions being routed directly for F2F treatment. The remaining 3.5% were referred for additional assessments before a decision regarding the most appropriate course of action was made.
On average, both the initial PAL assessment appointments and the initial F2F assessment appointments took place within less than one working day.
At the point of referral, 8.3% of the employees referred were absent from work due to their condition, while the remaining 91.7% were at work with pain and operating at a reported productivity level of just 68%. This highlights the hidden cost of presenteeism, the phenomenon whereby employees are at work despite not being fully fit, leading to a reduction in productivity levels and potentially slowing down the rehabilitation period.
Employees discharged from the F2F service received an average of 5.5 sessions each, including the initial assessment.
Of the 147 employees discharged from the service, only two remained off work following treatment and there was a reported average pain reduction of 67% (from 6.7/10 to 2.2/10). There was also a reported improvement in productivity and function in real terms of 27% (from 62% to 89%), equating to 1.35 days pp/pw working a five-day week and resulting in an overall increase of 43.5%.
98.6% of the 147 employees successfully discharged from the service returned to work following treatment, representing 145 employees successfully rehabilitated back into the workplace.
In financial terms and based on the average daily cost of a Trust employee being £100.00, the service has delivered significant returns. The improved productivity and function multiplied by the days saved in not waiting to access NHS treatment delivered a total estimated saving of £279,814.50 over the 12-month period – which equates to an ROI figure of 9.5:1
Dean Wilson, HR Director at SHSC, said: “With a large number of employees and wide variety of often physical jobs at the SHSC, the potential for our employees to suffer musculoskeletal injuries is high. It is essential that all our staff members can access quality care as quickly as possible so that they can return to work swiftly and safely, reducing the risk of their conditions worsening and allowing them to continue to deliver fantastic support to members of the community across Sheffield.
“By enabling our employees to be seen within days, rather than several weeks, the Physio Med service has delivered excellent results for the Trust, on both personal and financial levels.”
* National Survey, 2015
