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Seasonal Flu

Autumn may have started with a blaze of sunshine but hopes of lingering summer weather have now been well and truly dashed by the arrival of storms and heavy rain. It’s a stark reminder of the longer nights, dwindling temperatures and gradual descent into frost and slush that we will have to endure before summer once again peeps over the horizon.

The arrival of Autumn also heralds the start of this year’s flu jab campaign.  According to Public Health England, only 52% of those with an underlying illness took up the free jab offer last year (2013) and PHE are keen to increase that percentage as much as possible this winter.

So the call has gone out for young children, the elderly and those with underlying conditions to take up the challenge and get protected.  Professor Dame Sally Davies, the Government’s Chief Medical Officer said “I would urge those who are offered the free flu vaccination to visit their GP early in the flu season. I also urge all health care workers to make sure they are vaccinated to protect themselves, their patients and their families.”

When we think of the flu jab we naturally tend to think of it in terms of prevention of the flu itself but there are a number of other consequences of flu which put a strain on our health services. One of the more common of these is the need for some form of osteopath or chiropractic treatment as muscles or ligaments become strained thanks to the effects of coughing. When we cough or sneeze we put a tremendous percussive force on our bodies and this can lead to back and other injuries.

The effect of this is that not only do health practitioners need to stay healthy themselves to continue to treat their normal patients, they also have extra calls on their time to treat these flu-related injuries. And really these couldn’t come at a worse time.  One good bout of overnight frost and icy pavements add to slips and falls whilst icy roads lead to crashes.  These too put a strain on our health services with physiotherapists and other health practitioners having to cope with the aftermath of broken bones and strains.

Of course, if we all took up the flu-jab challenge then our health service would be far better off but as that is an ‘ideal world’ scenario it means that once again our health services may be stretched this winter.  Anything which can help to mitigate that pressure is therefore welcome and that is why numbers of health practices are adopting ways of working which will reduce the strain on their own resources.  Areas such as electronic filing of records, appointment reminders and the use of virtual assistant services to answer calls and book appointments can all help to smooth out administration time and therefore add to the time available for treatment.

As Public Health England says “Each winter hundreds of thousands of people see their GP and tens of thousands are hospitalised because of flu.” That puts a huge strain on resources so it’s no wonder that they are campaigning for as many people as possible to be vaccinated this year.

Prescribing Physiotherapy

New laws in Wales have opened up the way for physiotherapists, chiropodists and podiatrists to be able to prescribe medication to their patients. The change will bring Wales into line with England and Scotland which brought similar regulations into play in August 2013 and May 2014 respectively. The ability to prescribe medication is an important facet of physiotherapy and allied health services.

For a start, with physiotherapists and others prescribing medication as required, treatment pathways can be smoothed out with patients no longer having to wait for doctors to prescribe before they can continue a course of treatment.  Not only that, by integrating physiotherapy into the treatment/prescription mix, health professionals are able to deliver a more holistic treatment plan.  As a consequence, this practice speeds up recovery time whilst simultaneously reducing the burden on the rest of the NHS

Speaking about the new laws the Chartered Society of Physiotherapists said “We have noticed that the new powers have made a particularly strong impact in both neurological rehabilitation and in the treatment of musculoskeletal conditions, such as back and neck pain” whilst Welsh Health Minister Mark Drakeford said patients would get “a faster, more effective service with quicker access to the medications they need.”

Subject to training, other health professionals such as pharmacists and optometrists already have the power to prescribe. Moves such as these have the potential to have a profound effect on standards of patient care as well as making a more efficient use of health service resources. With increasingly busy lives and increasingly long lives, these resources are going to be stretched more and more unless further measures are taken to enable health professionals to optimise patient care. In fact, recent statistics have revealed that the number of those reaching the 100 mark has soared in the last decade, with (in 2013) nearly 14,000 people in the UK alone having passed that milestone with 710 living beyond 105.

Putting additional powers in the hands of those who need them is one way of helping our health services.  So too is any move which enables specialists to concentrate on clinical time rather than on administration time.  After all, if we are giving physiotherapists and other health professionals the tools which enable them to deliver a more holistic and complete level of treatment then the least we can do is ensure that their patient-facing time is optimised.

That’s where making the best use of technology comes into play. Measures such as on-line appointment books which patients or virtual receptionists can access remotely, electronic filing of patient records, or the ability to switch routine calls to a virtual receptionist service are all designed to free health professionals from routine administration tasks. Not only does this give those working in physiotherapy practices and other health services more time to practice the skills which they were trained for, they are also more able to take on additional clinical duties such as prescribing.

Working smarter not harder may seem like a cliché but it is one which can have a profound effect on patient recovery times and on the ability of health professionals to do their jobs to the best of their abilities.

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 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.

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.

Chinese Whispers

A GP who is at the forefront of patient engagement and empowerment has revealed that 99% of his communications with physiotherapists are still carried out on paper.  According to the Chartered Society of Physiotherapy, Dr Amir Hannan said ‘I don’t think we use email as productively as we might or technology in general.’

With letters being used as the prime communication method, it can sometimes be weeks before the results of patient treatments are conveyed to the general practitioner, resulting in delays in considering appropriate follow up treatment.  This affects the perception and actuality of patient care and can in some cases lead to a worsening of the patient’s condition.

In fact, Dr Amir highlighted the way in which delays in receipt of letters can result in the patient having to brief the doctor on the methods and results of treatments.  Whilst this does play into the hands of those who advocate patients taking responsibility for their care, it also means that treatments and findings can be filtered with a ‘Chinese whisper’ effect resulting in distortions.

Dr Hannan’s comments were echoed by NHS England’s director of systems, strategy and technology, Beverley Bryant, who confessed herself to be amazed “how much paper flies around our hospitals”.  As we have previously reported, one solution to this paper mountain is to adopt smarter practices which benefit from the use of current technology.  The health care authorities are working towards this end but there are options available now for those who need to find a way to communicate more effectively.

One of the main barriers to swift communication is the simple lack of time available to those who want to maximise patient treatment time.  Every time papers are filed, every time the phone is answered, every time an invoice is sent out is time which takes health practitioners away from their core task.  Simply by using the services of a virtual assistant to take control of telephone answering, diary management, electronic records and invoicing enables practitioners to free up valuable time.

Working smarter, not harder may be a mantra which is parroted around the business-speak airwaves on a regular basis but it does carry an element of truth.  Health practitioners took up the call to treat and improve the lives of others.  By concentrating on that calling and leaving the day to day admin to others, everyone benefits.

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.

I just called with a reminder

There are good calls and bad calls; calls you treasure, calls you feel are unwanted intrusions into your day and calls you will remember for the rest of your life.  But from time to time a call arrives which is so useful that you are simply pleased to receive it.

We refer here to appointment reminders, those simple texts or automated calls which remind you that your doctor/dentist/hair or other appointment is due.  They don’t take much but can play a huge part in ensuring that you do arrive at your appointment on time, thereby reducing the vast numbers of no-shows which daily cost health practitioners both time and money.

One recent convert to the benefits of automated reminders is the Great Western Hospitals NHS Foundation Trust.  From the start of August, those with outpatient appointments will receive a communication a week before their appointment date, asking them to confirm, cancel or rearrange.  The Trust hopes that this will make a dent in the 39,871 appointments which were missed in the last year.

In fact the trust has calculated that every no-show costs an average of £108 which means that the Trust spent over £4 million last year in dealing with those who failed to turn up for appointments, money which would have been better spent on providing treatment.  In announcing the new service David Moss, deputy general manager for outpatients, Great Western Hospitals NHS Foundation Trust, said: “By making sure all of our appointments are used, we can see more patients and patients will be seen sooner.”

But it is not just hospitals and NHS trusts which are affected by no-shows.  All health practitioners are similarly affected and for those providing direct-pay services such as physiotherapy, a no-show not only means another patient could have been treated, it also equates to a direct loss of income.

Contacting patients to remind them of their appointments can also take time out from that available for treatments.  One solution is to use a virtual assistant service to both make appointments and to send out reminders.  With diary management online the health practitioner can quickly view their upcoming appointments but still be free to maximise patient time.  Add in a patient notes service and even more time can be found for the practitioner to do what they do best, treating patients.

Workout at work day

Workout at work day 2013 has been hailed as a success with hundreds of events taking place across the UK.  From exercise classes and yoga to simple walks in the fresh air, the businesses taking part have all stepped up to recognise the benefits which they can gain through encouraging employees to exercise.

Organised by the Chartered Society of Physiotherapy (CSP), the day was billed as an opportunity for businesses to work with employees to develop a healthy lifestyle.  The CSP encouraged businesses to call in a local physiotherapist to show how simple changes in exercise or working patterns can make a huge difference to staff wellbeing and attendance levels.

According to the CSP, poor work habits such as sitting for long periods, not taking breaks and working late can all increase the risk of musculoskeletal disorders and stress, depression or anxiety.  This in turn can contribute to the millions of days lost every year due to employer-related ill health.  Taking time out to encourage employees to work fitter can therefore make a huge difference to a business.  In fact a report by The Work Foundation revealed that for every £1 spent on wellbeing initiatives, businesses gained £3 of benefits.

For physiotherapists too, this day brings the opportunity to make contact with businesses in their area.  This brings multiple opportunities for closer working relationships including the possibility of arranging contracted physiotherapy and advice sessions for businesses.  This type of service is already widely offered by other health-related practitioners such as chiropractors and is generally appreciated by employers and employees alike.

Of course this does raise the question of client contact when out of the office.  There is no point in arranging a weekly session at a local business if this means other clients can’t make appointments. The solution is to use the services of a virtual assistant. When you can’t answer the phone the virtual assistant can step in, taking calls and messages and arranging appointments.  This means that your business is never out of touch even if you are. Virtual assistants can also send out appointment reminders and organise patient records.

Workout at work day is a great reminder of the way in which health services can reach out and help people to achieve a better work/life balance.  Using a virtual assistant service to help when out of contact also means that health practitioners themselves can balance their work, home and client needs.

Physiotherapy, an essential part of dementia care

The National Institute for Health and Care Excellence (NICE) have published a new quality standard which aims to support people to live well with dementia.  The aim behind the standard (QS30) is that “a person-centred and integrated approach to providing care and services is fundamental to delivering high-quality care for people with dementia.”

In addition to acknowledging the importance of carers in the treatment of those with dementia the standard also looks at every aspect of a dementia sufferer’s care including leisure, health and relationships.  The standard also highlights the need for individual choice and control to be at the forefront of any programme especially when planning and evaluating services.

One element of the standard also looks at the importance of those with dementia and their carers being able to access “services that help maintain their physical and mental health and wellbeing.”  Whilst some of these services naturally include access to general practices and nurses, the list also includes care services such as hearing therapists, chiropodists and physiotherapists.

The Chartered Society of Physiotherapy (CSP) contributed to the development of the dementia standard with particular advice being sought from the network of physiotherapists who work with older people (Agile)*.  In commenting on the standard Agile chair, Janet Thomas, said “The dementia guidance we saw certainly had a different feel to other NICE guidance, with the emphasis shifted to the day-to-day living aspect of dementia care, and this is very important.”

With a growing body of evidence supporting the theory that “a healthy mind in a healthy body” is not just a saying but a vital component of wellbeing in later life, there is certainly something to be said for helping dementia sufferers to stay as active as possible.  Hopefully this means that those involved in physiotherapy and other related services will see a greater call on their time as they work with carers and those with dementia to help to provide an integrated holistic management programme.

Taking steps to reduce administration time, such as by managing diaries and storing patient records electronically, will help to maximise treatment time and hopefully enable physiotherapists to take their place at the forefront of this new approach to care.


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