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SPORT AND EXERCISE MEDICINE (SEM) IN PRIMARY CARE: A NOVEL DUAL ARMED APPROACH TO IMPROVING PHYSICAL ACTIVITY (PA) AND MUSCULOSKELETAL (MSK) SERVICES IN A HERTFORDSHIRE GENERAL PRACTICE
  1. S Chew1,
  2. J Noake2
  1. 1 Hertsmere CCG Musculoskeletal Service & UCLH & Imperial NHS Trust
  2. 2 Hertsmere CCG Musculoskeletal Service & Imperial NHS Trust

Abstract

Background With the advent of SEM as a recognised medical specialty in the United Kingdom, a number of service models have become apparent.1 Despite government initiatives to increase for example PA promotion in the primary care setting, uptake, promotion and utilisation of these services has been poor or lacked longevity.2 Schopwick General Practice has a patient population of over 12,000 and is a standard primary care service provider.

Aim To develop a holistic reproducible dual armed model of SEM services in the primary care setting that is economically viable and sustainable.

Methods Two SEM registrars in conjunction with the practice partners and manager, proposed, implemented and piloted a SEM service providing both musculoskeletal and physical activity interventions. Care provision included “one-stop” MSK clinics with capabilities for “see and treat” injection therapy, rehabilitation prescription & allied priority physiotherapy appointments. Novel PA prescription templates to assist practitioners were embedded in consultation software, & electronic ‘flag’ systems developed to highlight priority intervention patients. GPPAQ was made a mandatory component of the “new patient” registration procedure. Over a 12 month period audit of parameters including orthopaedic referral rates, frequency of physical activity interventions according to electronic note records, and patient service questionnaires were used to assess outcome measures of the service.

Results Documented PA advice increased fourfold over a 9 month period. Use of GPPAQ Pre and Post January 2011 increased significantly. All use Vision Exercise Related Read Codes Pre and Post January 2011 increased fivefold. Orthopaedic referral rates were reduced by approximately 50%, MRI scan requests were reduced by over half and in-house physiotherapy waiting times were reduced from 8 to 6 weeks despite the introduction of service specific appointments.

Conclusions Novel service models marrying both musculoskeletal and physical activity promotion services can make sound economical and patient satisfaction positive outcomes within primary care settings. We present a reproducible model that has recently been commissioned as a service by the local clinical commissioning group.

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