The problem:

Musculoskeletal conditions affect millions of people in the United Kingdom and are a leading cause of physical pain, psychological suffering, and functional limitations. They create a huge burden for individuals, health services, and economies alike. The majority of treatment is provided in a community setting by physiotherapists and GPs.

 

The drive to deliver services closer to home has led to a geographical fragmentation of musculoskeletal services and staff. The introduction of specialist musculoskeletal clinics has led to a fragmentation of knowledge and skills, as many experienced staff are no longer based in ‘core’ physiotherapy services.

 

This has resulted in a dispersion of the knowledge and skill base across each site and service. As an unintended consequence, physiotherapy staff working within these services often feel it is harder to access peer support. This peer support is vital in helping physiotherapists synthesise their learning, critically reflect, and then apply their learning to practice.

 

Access to a second opinion typically requires a referral to a musculoskeletal service. This adds a delay into the patient journey, increased cost, and reduces continuity of care. Easier access to peer support could reduce the need to refer, increase the quality of required referrals, and improve clinical outcomes.

The Idea:

Physiotherapists treating musculoskeletal conditions face the daily challenge of dealing with patients suffering with up to 200 different conditions. In addition to increased demands on capacity, there has been an increase in the complexity of referrals into ‘core’ physiotherapy and musculoskeletal services

 

The proposal is to provide a protected space for peer support between physiotherapists in different geographical locations and services that all provide treatment for patients with musculoskeletal conditions. As the staff are currently located across 11 locations and 3 services (physiotherapy, musculoskeletal, and orthopaedics), this peer support would be provided through regular face to face meetings run in the form of an ‘MDT’ or ‘virtual case conference’. They would be ‘chaired’ by a senior clinical member of the services involved and would last 45-60 minutes.

 

The purpose of the meetings would be to discuss problem (routine) patient cases, to discuss problem patient groups, and to discuss problem professional areas. A range expertise ‘contact’ cards will be also created, to allow the most appropriate signposting outside of the meeting. The discussion and actions will be recorded, along with the overall clinical outcome from cases discussed at the peer support meetings.

 

These meetings will provide a safe space for case discussion and direct access to peer support. They will help to bridge the gaps that have developed within musculoskeletal services, and will help in supporting staff to improve their clinical reasoning, identify areas for professional development, and improve synthesis of learning and application to practice.

The benefits for Q:

The aim of this project is to improve peer support for staff treating patients with musculoskeletal conditions. The drive to deliver services closer to home spans most traditional community services, and now an increasing number of hospital services. This is likely to lead to similar peer support issues within those services. This project, as a case study and as an emerging model staff peer support, would be beneficial for other Q members facing similar challenges. Materials for the Q website and conferences would help in disseminating the good practice from this project to other Q members and service areas.