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Everything in moderation

Saturated fats, salt, alcohol, exercise, diet; the list of potential causes and prevention methods for cancer, heart problems and other life-threatening conditions changes on a daily basis. For every report which boldly proclaims that x is bad for you, another is sure to follow with a counter argument.

Even the idea of healthy exercise is under threat as a recent report reveals that working out at the gym may not help us to lose weight. With all of this contradictory advice it’s hardly surprising that some choose to ignore it completely whilst others present themselves at the osteopath or chiropractor with injuries from having jumped from one fad into another.

Calmer minds accept that the solution is to adopt the mantra ‘everything in moderation.’ Ignoring the fads and balancing a healthy diet with moderate exercise is arguably the best advice which anyone can have. Similarly, when it comes to a busy lifestyle, rather than flying from one extreme solution to another, the best advice is to take a good look at the schedule and find ways to reduce the overall workload.

When we encounter overload in our daily lives it is tempting to cut out some elements entirely. For example, a busy physiotherapy practice may take the decision to stop taking on new patients. Of course the danger in this is that we lurch from one crisis to another, cresting more problems with every ‘solution’ until we fall into some kind of stasis: just about managing but unable to grow or enjoy our work.

But one of the benefits of the internet age is that there are other options available which can take the strain without needing to resort to drastic measures.  Services such as diary management, phone answering and even electronic filing of patient records can all be handled by a virtual assistant service. And with today’s telephony systems enabling callers to be pre-announced, a virtual assistant service can answer calls in the name of the health practice even if they are looking after a number of practices at the same time.

Add in an on-line booking service allied to secure card processing and at a stroke the day to day administration workload of a busy health practice can be switched from overload to manageable. Not only that, by taking card details at the time of booking, clients are far more likely to attend appointments; helping to maximise treatment times and ensuring that the physiotherapist or other health practitioner is spending their time productively rather than chasing no-shows.

With administration time cut, the health practitioner is freer to concentrate on what they do best; helping those who are in need of some form of therapeutic intervention. Best of all, the virtual assistant service is flexible and can be switched on and off as required. So if ‘pinch points’ only occur at certain times of the day, week or month, the virtual assistant can step in then, leaving practices free to self-manage at other times.

Everything in moderation? With a virtual receptionist service on standby, health practices can smooth out some of life’s pressure points and that can only be good for the health practitioners and for their patients.

Medal-Winning Physiotherapy

The 2014 Glasgow Commonwealth Games got off to a flying start with a flurry of medals on day one for the host nation.  But whilst all eyes are on the athletes themselves as they strive for victory, it can be easy to forget those who work hard behind the scenes to make the Games a success.

From cleaners to ticket collectors and from chefs to medical staff, those who volunteer or work at the games are on the front line when it comes to building Glasgow’s reputation.  For these games the medical team is headed by physiotherapist Liz Mendl.  Liz is in charge of some 1,400 volunteers including 400 physiotherapists.

Building on her experience of previous Commonwealth and Olympic events, Liz has introduced two innovations for these games.  The first is to head up each medical room with a ‘lead physiotherapist’ who is responsible for running the room and ensuring that those in need of help swiftly receive the appropriate treatment from the right member of the multidisciplinary team.  The second innovation is to instil ‘first contact’ physios at training venues to provide instant help for those who don’t have access to a team physio.

On their website the Chartered Society of Physiotherapy (CSP) highlights some of the many physiotherapists who have volunteered to help at the games.  Browsing through the summaries provided by the volunteers it is hard not to get an overwhelming feeling of the dedication and commitment which physiotherapists give on a daily basis.  Volunteer Emma Knott comments that “there is much more to physiotherapy than the magic sponge!” perhaps summing up best the challenge faced by the profession in helping people to truly understand the role which physiotherapists can play in keeping people fit and healthy. Yes, some may be called upon to deliver remedial treatment following one-off injuries; but physiotherapists also work with people in order to mitigate life-limiting conditions or even to help individuals to stay supple, preventing injuries from occurring in the first instance.

Measures, such as those introduced by Liz at the games, can only help to improve the public perception of the role of physiotherapy within the health profession. But this in turn may bring fresh challenges to the profession. Once physiotherapists are seen as front-line first-contact health professionals rather than ‘when everything else has been tried’ last resorts the profession is going to become even busier.  When time is at a premium the last thing that should be affected is patient treatment.  After all, when you have spend years training to bring your skills to benefit others, the last thing you want to do is to see valuable time spent on routine administration. Time saving measures such as online booking, diary management, electronic patient records and appointment reminders can all help to reduce time spent on administration, thereby maximising patient treatment times.

If the remainder of the games match up to the excitement on Day 1, then we are in for a feast of sport.  Let’s hope that the medical team aren’t kept too busy and can enjoy some of the events which they have given up their time to support.

The cost of health

The Royal College of Nursing (RCN) has overwhelmingly rejected a proposal to charge patients for NHS appointments.  Had the proposal been successful it would have led to the RCN backing the idea of a £10 charge for health appointments, but in the end 91% of delegates at the RCN conference voted against.

Those in favour of the proposal said that making a charge would not only raise much needed revenue for the NHS it would also emphasis the value of NHS appointments.  In other words, charging for appointments would help people to appreciate the value and cost of NHS appointments and in the process make people think a little more about the way in which they use NHS resources This would in turn, the proponents argued, result in the twin benefits of reducing unnecessary appointments and reducing no-shows; both of which waste considerable NHS resources as well as potentially delaying urgent treatments. After all, it helps no-one if health practitioners are sitting idly by waiting in vain for someone to turn up. That time would far better be used in helping another patient.

Commenting on the vote a spokesperson for the Department of Health said “We are absolutely clear that the NHS should be free at the point of use, and we will not charge for GP appointments.”  But with no-shows a constant drain on both NHS and private health care services, practices are increasingly turning towards the use of appointment reminders as a means of encouraging people to attend booked appointments or to cancel them in good time.

Sent by phone, SMS text or e-mail, appointment reminders not only jog patients’ memories, they also act as a spur for patients to get in touch and cancel appointments if they are unable to attend.  This in turn enables health practices to re-book appointment slots.

For health practices such as osteopaths or physiotherapists which do charge for appointments, not only do no-shows waste valuable treatment time, they also act as a cost drain on the practice.  Whilst the option of sending out appointment reminders is one option, another great way to cut down on no-shows is to take a secure card pre-authorisation at the time the appointment is booked.  Having a card pre-authorised tends to sharpen the mind when it comes to remembering to attend appointments. Pre-authorising a card doesn’t prevent the patient from paying by other means when they attend the appointment but should the patient not attend the health practice can charge a pre-agreed sum to the card.  Pre-authorised card booking can be taken either over the phone or when an appointment is booked online.

With a report from the BBC revealing that the NHS may be facing a funding gap of some £2billion in the next year, we suspect that the debate about the way in which health care is funded and managed will rumble on for some time.  Adopting systems such as appointment reminders which help to ensure patient care is delivered when it is required whilst at the same time maximising resources can only be a positive move.

The power of sport

It may be the top sportsmen and women who hit the headlines but the power of sport to engage and enthuse at all levels never ceases to amaze.  From rumbustious back street kick-abouts to photos in the Guardian recently of Brazilian children practicing overhead kicks on a flooded pitch; sport can be a unifying and defining activity.

One thing is certain, with Wimbledon and the World Cup around the corner, our streets and parks will soon be filled with enthusiastic sports players all dreaming that one day they will be able to emulate Murray or Messi, Nadal or Neymar.  But, played at any level, sport can come at a price.

That price is the chance of injury.  You may be a top flight sportsperson, used to training every day and carefully balancing nutrients to optimise body health and fitness.  You may be a weekend player, turning out for the local team before heading off for a drink; or you may be an occasional player, turning out with short bursts of enthusiasm before retreating to more sedentary forms of support.  Whatever level you play at, the odds are that injury will hit at some stage.  And when injury hits, the quicker it is treated the better.

For health professionals such as physiotherapists, chiropractors, sports injury practitioners and osteopaths, the challenge is to be on hand to treat regular clients, whilst at the same time squeezing in more immediate cases.  No-one wants to leave diary slots vacant but equally no-one wants to turn down prospective patients.  The answer is to take every opportunity to ensure that prospective clients can make and attend appointments.

Online booking will capture some clients but others may prefer to speak to a person at the end of a phone.  Switching phones to a virtual assistant will help to ensure that when the phone rings, someone will answer without the need to interrupt ongoing treatments to answer the phone. In fact, using a virtual assistant service has multiple benefits including improving the image of the health practice, establishing a dialogue with clients and freeing up treatment time which would otherwise be spent in answering or returning telephone calls.

Once the appointment has been made it is important both for the patient and the health practice to ensure that treatment starts in the timescale agreed. No-shows not only delay the start of important treatments, they leave empty gaps in health practitioners’ diaries which could have been filled by other patients.

Encouraging clients to keep the appointments which they have made is a two-fold process.  Appointment reminders sent out via SMS text or e-mail have been shown both in the NHS and private practice to reduce the number of no-shows.  Similarly, confirming bookings with a pre-authorised debit or credit card sum also serves to improve attendance rates, generally because this means that the health practice can take a non-attendance fee in accordance with advertised practice.

World cups, tournaments, championships; the sporting calendar rolls ever onwards and with every passing phase brings a new crop of injuries.  Making sure that they are on hand to provide prompt treatment will earn health professionals their own niche in the sporting hall of fame.

Optimising Sporting Performances with help from your dentist

What does it take to help an elite athlete to stay at the top of their game?  Good nutrition, a balanced training regime, access to the best physiotherapists and osteopaths?  Well if a recent (April 2014) conference in London is anything to go by the need for good oral hygiene and a trip to the dentist should be added to the list.

In September 2013 a study published in the British Journal of Sports Medicine revealed low levels of oral health among London 2012 athletes, with 40% being bothered by oral health problems and 18% reporting that dental problems impacted on training and performance.  The study was carried out on a cross-section of athletes competing at the games.

Now the oral health and performance in sport conference in London has backed up those findings with a series of discussions and presentations on the impact of oral hygiene on sporting performances.  Whilst good dental hygiene won’t turn a novice into an elite athlete, for those at the pinnacle of sport where the slightest edge can make the difference between Olympic Gold and also-ran, it seems as though dental hygiene is a contributing factor.  And the effect is not just confined to those who seek to be ‘the fastest’.  The British boxing team have already noticed a difference since regular dental checks were introduced as part of the training regime.

But good dental hygiene is not just for athletes.  Type 2 diabetes and heart problems have also been linked to poor oral health, making a visit to the dentist a potentially life-saving activity.  Plaque can lead to gum inflammation and studies have shown that inflammation anywhere in the body, including in mouth and gums, can have a detrimental effect on arterial health.  So studies have concluded that regular brushing and attention to oral hygiene including trips to the dentist can help to protect heart health.

But as the British boxing team managers found, a visit to the dentist is not on many people’s priority list.  It is important therefore to ensure that making appointments and contact with the dental surgery is made as easy as possible.   Systems such as online booking and automated appointment reminders can make a huge difference to attendance rates.

Whilst a nagging toothache is a strong enough reminder that something needs to be done, without pain our impulses to make a check up appointment are fleeting at best.   Being able to log in via PC or smart phone and book on the spot enhances the chances of capturing that fleeting idea.  And for surgeries which operate a ‘book your next appointment now’ system for those who do visit, an automated appointment reminder will help to decrease no-shows from those who forget the appointment that they made six months ago.

Talking about the boxing experience, Dr Mike Loosemore said of the enforced dental checkups: “They may not appreciate it now, but hopefully they’ll appreciate when they’ve got a gold medal round their neck in Rio.” For non-athletes the reward may well be a lessening of the chances of heart or diabetes problems in later life.

Back to basics

A global research study has concluded that lower back pain is the leading cause of disability and work absence across much of the globe.  Researchers from institutions in Australia, the US and the UK including the Royal Cornwall Hospital found that whilst there is no evidence linking back pain with a higher risk of early death, it can cause long term disability.

Across the world the study estimates that nearly 1 in 10 suffer from lower back pain with the figure rising to 15% in Europe.  An increasingly aging population is only going to exacerbate the issue which can cause emotional and financial as well as health problems for sufferers.

Although lower back pain has no one common trigger point, typically causes include poor posture when sitting or standing, bending awkwardly or failing to follow lifting guidelines.  Acute back pain can also cause leg pain which adds to the difficulty of moving and walking.  In its extreme form it can also impact on everyday tasks such as washing or dressing.

With the incidence of lower back pain expected to increase alongside an ever-aging population this condition places a strain on all health professionals.  Whilst doctors and health visitors are more likely to be in the front line, others such as physiotherapists, osteopaths and chiropractors will all take up the burden of day to day treatment.  Maximising patient time and minimising administrative burdens will therefore form an essential part of the way forward in treating this debilitating condition.

For the health professional this will require a switch to “always on” technology which will help patients to book appointments and stay in touch without taking up clinical time.  This includes taking steps to ensure phones are covered by internal or external support staff, appointment booking online and automatic appointment reminders.  These simple steps can make a huge difference both to treatment times and to ease the strain on overworked health professionals.

In its review of the study, the NHS Choices website concludes that it may be a cliché to say that doctors don’t understand the back but it acknowledges that lower back pain is a “poorly understood condition.” The site therefore calls for further research into the ways in which back pain can better be prevented and managed.  Pending the outcome of such research it will fall on health professionals to take steps to manage their back pain management in the most effective way possible.

Changing the UK’s Health

Sometimes for change to happen it requires a seismic shift in technology or actions, but on other occasions a series of small individual acts can come together to create something special.  That was the idea behind NHS Change day; a time when individuals can make small pledges which could result in significant change for the NHS.

At the time of writing over 450,000 people have made their pledges and with the last pledge date for 2014 still some weeks away the final total is expected to be far higher.  Some pledges are designed to support and strengthen local campaigns whilst others have been made on a far more individual basis.

One national campaign which the NHS is promoting through NHS Change Day is the idea of reducing no-shows.  With 12 million GP and 6.9 million hospital appointments missed in the last year costing a total of £270m, every person who makes an individual pledge not to miss an appointment in future will be saving the NHS money and improving treatment for themselves and others.

In an attempt to cut down on no-shows NHS practices are adopting a range of measures from reminder calls and texts to encouraging direct booking online.  But it is not just health practitioners within the NHS who suffer from missed appointments.  Health practitioners across the board from chiropractors to physiotherapists and from beauticians to counsellors all suffer if a patient fails to attend an appointment.  And in many of these cases it is not just the taxpayer who loses out but the health practitioner themselves, not to mention other patients who could have taken that vacant slot.

So for health practices everywhere, anything which can be done to cut down on no-shows should be done.  Appointment reminders, online booking services, ensuring continuity of telephone answering; all can play their part in working towards a full diary and effective treatments.

The pledges being made for NHS Change day are not just confined to reducing missed appointments.  Challenging culture, enhancing leadership, patient safety, improving skills, the list goes on.  Some of the pledges are from patients, others from those on the front line or back office who are working to improve the NHS from within and without.  From individual pledges to walk more or eat healthily to sharing knowledge and experience with others, the pledges may individually not be earth shattering.  But if enough people see the pledges and join in then health care for all could be the winner.

A ‘Wellcome’ cure

The Wellcome Library has opened up its archives of historical memorabilia for general use.  According to the library the collection encompasses ‘manuscripts, paintings, etchings, early photography and advertisements’ and amounts to some 100,000 images.

Releasing the images under the Creative Commons Attribution Licence means that they can be used free of charge by anyone for personal or commercial purposes, provided that the image is accompanied by an acknowledgement as to source.  So whether you are treating your patients for gout or for sprained limbs, for persistent pain or for an aching tooth there may well be a suitable image which you can use to amuse or to inform your patients.

In opening up the archive the Head of the Wellcome Library, Simon Chaplin, said “Together the collection amounts to a dizzying visual record of centuries of human culture, and our attempts to understand our bodies, minds and health through art and observation. As a strong supporter of open access, we want to make sure these images can be used and enjoyed by anyone without restriction.”  The earliest image in the collection is a fragment of an Egyptian herbal, inscribed on papyrus.  From that early beginning the collection encompasses medieval manuscripts, Victorian cartoons and some early photographs exploring the movement of the human body.

Providing effective patient treatments can be challenging at times and those working in the health profession know that keeping the tone light and adding touches of humour can help to alleviate patient anxiety.  Access to an archive such as this can help to make the difference; although whether some of the images such as the Gilray cartoons portraying gout sufferers drinking port will teach us anything is a matter for debate.

But to be truly effective light heartedness needs to be tempered with professionalism and this is not always easy to achieve in a busy health practice.  Answering the phone, finding or filing patient notes, sending out invoices and other administration tasks can all disrupt patient treatments.  Outsourcing some of this work to a virtual assistant service can help to smooth over the working day and maximise time taken on treating patients.  Virtual Assistant services can be taken on a permanent or ‘as required’ basis.  This means that health practitioners can concentrate on what they do best, treating and reassuring patients, whilst being reassured themselves that behind the scenes day to day administration tasks such as phone answering, appointment reminders and invoicing are not being neglected.

Time to ski

With Bonfire night safely out of the way it is time to turn our thoughts ahead to the winter ski season. Whilst some forecasters have predicted a harsh winter ahead for the UK in 2013, the Met Office recently took pains to stress that it is still too soon to produce an accurate forecast and accused those who are predicting “the worst winter in decades” of crystal ball gazing.

Whatever the outcome, UK winters are still too unpredictable to guarantee good snow leaving ski enthusiasts having to look elsewhere to get their skiing fix. This means that the annual exodus to the European slopes and further afield is about to get underway.

The first week in November has already brought a good snow covering to some alpine resorts, resulting in predictions of an early start to the season and no repeat of last year’s green slopes.  Hopefully the weather conditions will bring good safe skiing but whilst the majority will return safely from their adventures, there will be some who suffer on the slopes and need attention on their return.

It’s not surprising therefore that whilst eager skiers travel outwards, back in the UK physiotherapists and other health professionals are bracing themselves for a busy winter.  Broken limbs, strains and pulls are an inevitable consequence of skiing accidents.  Add in those whose year-round sedentary lifestyle has not prepared them for the physicality of skiing and chiropractors, osteopaths, and physiotherapists alike are an unforeseen consequence of a winter holiday on the slopes.  And if winter in the UK does turn out to be harsh then there will be an additional crop of home-grown injuries to treat.

Hopefully some individuals will have thought ahead, consulting health professionals for pre-ski exercise regimes which will prepare them for a holiday on the slopes. And hopefully some people (particularly the elderly or frail) will have prepared for icy conditions at home, stocking up on essential supplies or arranging for additional support perhaps from a neighbour or health professional. But many won’t be prepared and even if they are, it is impossible to guard against accidents. All this means additional demands on the services of health professions who in turn will need to gear up their timetable to run as smoothly as possible. This includes taking steps to ensure that the time given to treatments is maximised.

All this means that health professionals need to gear up their timetable to run as smoothly as possible.  Missed appointments not only means a lack of income but also another patient who will not be speedily treated.  Having to interrupt treatments to take phone calls means that treatment may not be as effective as it should be.  And if calls are missed then patients suffer and diaries are not as full as they should be.

The answer is to bring in the services of a virtual assistant.  With calls answered, diaries can be maintained as full as practicable without patent treatments suffering.  Add in an appointment reminder service and no-shows are reduced again helping diaries to be maintained at an optimum level.  Skiing can be fun, but when something goes wrong, a speedy return to fitness with quick and professional help is the best way to prepare for the next season on the slopes.

Telephone reminders

We’ve written before about the way in which telephone reminders can help to cut down the number of no-shows but it is always a pleasure to be able to report on a practical example.  Earlier this year the Great Western Hospitals NHS Foundation Trust introduced a reminder service for those with outpatient appointments.

Since the reminder service started the trust reports that no-shows have reduced by a third and the trust is therefore expanding the service to its physiotherapy departments.  Using a mixture of texts and automated calls the trust decided to adopt the appointment reminder service as a way of cutting down on the 39,871 appointments missed in 2012.

In announcing the extension of the service the trust’s deputy general manager responsible for outpatients told the Wiltshire Times: “The reminders seem to making a real difference. I hope that patients find the service helpful and it makes it easier to cancel or rearrange. If we know a patient won’t be attending, we can offer the appointment to someone else. By making sure all of our appointments are used, we can see more patients and patients will be seen sooner.”

Patients who fail to show up for appointments are not just a problem for NHS trusts.  Health practitioners everywhere from osteopaths to physiotherapists and from beauticians to specialised health clinicians all need to run with as full a schedule as possible if they are to remain competitive.  Not only can missed appointments lead to delays in treatment times for the patients concerned and others, for those who rely on the appointment to generate income, every gap is a loss.  The Wiltshire trust estimated that for them each missed appointment cost some £108 and the opportunity cost charge can easily be higher for those in private practice.

It is hardly surprising therefore that telephone appointment reminders are increasingly becoming a necessary feature of health practice.  This writer has received reminders within the past few months from their optician, dentist and doctor, all of whom have adopted versions of the reminder system.  Set alongside a virtual assistant service which can also take calls and arrange bookings, even the smallest of health practices can move towards a fuller diary with fewer no-shows.  This in turn means that health practitioners can keep their prices competitive whilst maximising both their income and patient treatment times.

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