No abstract

No abstract

PurposeWaiting times for secondary care orthopaedic appointments have been problematic for many years and led to the development of services outside traditional secondary care settings. The purpose of this paper is to question the sustainability of a primary care musculoskeletal interface service in the face of continuing policy change and future upheavals in the NHS design.Design/methodology/approachThis paper considers the political, organisational, and governance issues faced by the NHS Bath and North East Somerset Orthopaedic Interface Service (OIS). It discusses critical factors that test its viability.FindingsThe OIS retain 50 per cent of orthopaedic patients referred via the Choose and Book system. Of those, 21 per cent of patients seen were referred onto secondary care, the rest are managed in primary care. Patient feedback on their experience within the OIS service is overwhelmingly positive.Practical implicationsThe experiences described could be of value to new services, or for future benchmarking.Social implicationsIncreasingly services will be provided outside traditional secondary care settings. There needs to be an increasing emphasis on self‐management as resources become increasingly under pressure.Originality/valueThe paper will be of interest to clinicians, commissioners, providers and possibly the general public. There was a flurry of literature when these services were first established but there has been less published of late, and this paper provides a contemporary perspective.

No abstract

Objective To investigate the recruitment to, and value of, an expert patient programme as part of the physiotherapy management of patients with chronic spinal pain. Design A qualitative design incorporating semi-structured audiotaped interviews subsequently transcribed and coded. Interviews were held with patients as individuals and a group of nine physiotherapists participating in a single focus group. Setting Interviews were held in a physiotherapy department within a small community hospital. Method Initially an expert patient programme was organised and 20 patients were recruited. Interviews were held with five patients who had declined to participate and five patients who agreed. Those who agreed were interviewed before and after participation in the programme. Nine physiotherapists involved in recruiting patients to the programme were interviewed collectively in a one-off focus group. Results Patients and physiotherapists were not well-informed about the expert patient programme and were uncertain as to its value. There was resistance amongst patients to join the programme for logistical, perceptual and personal reasons. Recruitment was time-consuming for the physiotherapists involved and required persistence, commitment and persuasiveness. Some physiotherapists felt that they had inadequate time to recruit patients and were uncertain as to who would be suitable. Attendance on the single programme studied was poor, with two out of a potential 12 patients attending all six of the sessions. Participants who attended the programme found it a positive and useful experience. Conclusions This study confirms previous work that found a low uptake of places on programmes and difficulties in recruiting. Physiotherapists managing patients with chronic spinal pain are unsure as to the efficacy of expert patient programmes but feel that they could be useful for a small number of patients who are psychologically ready and sufficiently motivated to join. Patients who are successfully recruited to a programme can gain benefits including empathy and support. Further work needs to be carried out to demonstrate the value of the programme to both patients and physiotherapists.