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Last Updated: Sunday, 29 January 2006, 01:06 GMT
'Super physios' redefine NHS care
By Nick Triggle
BBC News health reporter

A government white paper, to be published on Monday, is aimed at improving access to community NHS services.

For many people this means more GPs, but in many poor areas the solution is not so simple. A more flexible approach is being taken in a deprived part of the West Midlands.

Sue Harvey
"Super physios" work from the Partners in Health Centre

With its spacious waiting area, team of receptionists and series of consultation rooms, Birmingham's Partners in Health Centre is easy to mistake as a modern GP practice.

So it is not surprising that some patients seem shocked when they do not see a doctor.

"Some can be a bit sceptical," said physio Sue Harvey. "But when they come in and get to spend 45 minutes or so with us, which after all is much longer than they would get with a GP, they soon change their minds."

The health centre - staffed by a team of "super" physios, dieticians and nurses - forms a key plank of east Birmingham's redesign of community NHS services.

Historically, the area - among the most deprived and least healthy in the country - has struggled to attract GPs.

Local health bosses responded a few years ago by deciding to give more responsibility to nurses and other health professionals, such as chiropodists and physios.

Benefits

The measures have had the twin benefits of easing the pressure on GPs and helping reduce expensive hospital admissions - one of the key aims of the forthcoming white paper on out-of-hospital care.

Ms Harvey, who used to be based mainly in hospital, has undergone extra training and can now give injections, analyse X-rays, order diagnostic tests and refer patients on to hospital consultants in her role as an "extended scope practitioner".

COMMUNITY CARE
Partners in Health Centre, Birmingham
Orthopaedic triage unit - Operates mainly from the Partners in Health Centre, deals with all musculoskeletal patients
Community diabetes team - Led by consultant nurse and consultant diabetologist to provide care in community settings, some done at Partners in Health Centre
Community matrons - Team of 15 senior nurses with responsibility for long-term conditions such as asthma
GPs with specialist interest - Eight GPs run specialist clinics in areas such dermatology, heart failure and ear, nose and throat treatment
Care homes Parkinson's disease service - Specialist nurse liaises with 14 local care homes for the elderly to help patients manage condition

The service she offers goes way beyond the normal work of physios and has meant patients with musculoskeletal problems from sport injuries to arthritis are no longer bounced between their GP, hospital and physio.

Of the 3,211 patients seen by the orthopaedic triage team since it started dealing with all musculoskeletal referrals in March, 70% of them would have traditionally ended up in hospital.

Sue Roberts, head of physiotherapy at Eastern Birmingham Primary Care Trust, said: "The idea is to give physios the powers and skills to deal with problems. Of course, when it is really serious it goes straight to the hospital.

"But in the past patients who do not need to see hospital consultants have spent time going back and forth. That is not best for the patient or NHS."

The physio service is just one of a number of treatments available at the centre, including diabetes, heart failure and smoking cessation therapy.

But experienced nurses and health professionals also operate across the rest of east Birmingham in traditional local health centres and GP practices.

Nurses have started to become more involved in smoking cessation - clinics have even been run in a Boots store to bring health services on to the high street - and monitoring blood pressure.

Consultant nurses have been appointed to run specialist diabetes and public heath services and by January a team of 15 community matrons will be providing much of the care for people with chronic conditions.

Pharmacists have also got involved by conducting medicine reviews on patients, a role traditionally filled by GPs.

The redesign of services has meant more nurses and other health professionals - a 25% increase in the last three years - matched by a similar rise in investment.

Vacancies

In contrast, there has only been a marginal increase in family doctors - although the 12 vacancies Eastern Birmingham PCT inherited when it was formed in 2002 have been filled by "salaried GPs".

The group of family doctors are employed by the PCT, rather than self-employed as most NHS GPs are, a scheme which has attracted young medics wanting the flexibility of not being tied down by buying into the practice.

The trust has also looked to safeguard its supply of nurses in the future by linking up with Wolverhampton University to set up a course for existing nurses, predominantly those based in hospitals, to train them to become specialist community nurses.

Dr Mehboob Bhatti
GPs have broadly welcomed the changes to services

PCT chief executive Sophia Christie said: "Services have been completely redesigned. It has always been hard to attract GPs to an area such as ours, so you have to look at other ways.

"But it is also about changing the culture of the NHS so there is more choice and better access."

But what do the public make of the changes? The local patients' forum said some people have needed convincing when they do not see a doctor, but with quicker access and speedier treatment most have been won over.

And the most recent surveys of opinion showed satisfaction levels of over 70%.

The move has even been welcomed on the whole by GPs.

Disease

Dr Mehboob Bhatti, head of clinical governance among east Birmingham's GPs, said: "Some of the older doctors have been resistant to the changes, but most have welcomed them.

"Patients are getting a choice of different types of excellent care and, in turn, GPs have been given a bit more time to develop specialisms."

East Birmingham now has eight GPs running specialist clinics in areas such ear, nose and throat treatment and chronic obstructive pulmonary disease, some of which is done from the Partners in Health Centre.

The clinics offer the kind of treatment that is normally done in hospital, including minor surgery.

But despite the achievements, the move towards this more "sophisticated" model of out-of-hospital care has not been without difficulties.

The trust has had to delay the recruitment of some senior nurses and establishment of advanced training schemes to ensure it breaks even - the entire NHS is currently gripped by financial difficulties with one in four trusts ending last year in deficit.

"What we need from this white paper," said Ms Christie, "is for primary care to be incentivised. It had to be given the focus it deserves. After all nine in 10 patients are seen at this level."




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