Joint venture: how an NHS physio waiting list was shrunk in just two days
Long waiting lists full of people with complex conditions. Consultations by rote. Signposting that wasn’t leading anywhere. The problems faced by a Sussex NHS physio practice were familiar ones.
That was until the team decided to change things. They booked out a local leisure centre and invited their entire waiting list for a Community Appointment Day, full of conversations, not consultations.
This venture achieved immediate results – with average waiting list times reduced by a third.
Adam Lent visited practitioner Laura Finucane and manager Natalie Blunt to ask how – and why – they did it, the inspiration they drew from New Local’s work, and what comes next.
Adam Lent writes:
Is it possible to significantly reduce health and social care waiting lists overnight? It may seem like a policymaker’s – or patient’s – pipedream. But a new innovation suggests it is.
I recently visited a physiotherapy team in Sussex, who have managed to reduce the average waiting time for appointments from 16 to ten weeks in just two working days using community power and strengths-based approaches.
The brainchild of Laura Finucane, the Clinical Director of Sussex Musculo-Skeletal (MSK) Partnership, the initiative is known as ‘Community Appointment Days’ (CAD). It began by inviting everyone on the routine physiotherapy waiting list to an event in a leisure centre hall on one of two days in April 2023. On the day, attendees could have a guaranteed conversation with an MSK clinician, be directed to support groups that were present ranging from large charities to small community groups, access wider health and well-being services, and even get immediate rehabilitation treatment.
The outcomes were impressive. 550 people attended over the two days. Half of those were discharged from the waiting list. And a third were connected on the day to a community service. And, of course, there was that immediate reduction in average waiting times. These have remained steady with only 10% of those discharged from the list at the CAD returning and fully half of those only requiring one further consultation. Indeed, many of those who attended the CAD simply required advice and support rather than significant medical intervention or intensive help.
One absolutely vital success factor was the decision to take a strengths-based and community powered approach. Laura and her team were very clear that the CADs could not simply be a more intense and speedy version of conventional medical consultations. Clinicians were trained in strengths-based conversations which aim to find out what really matters to a person rather than treating them as a medical problem. This was vital because it allowed clinicians to identify resolvable but non-medical issues that might be causing or exacerbating an MSK condition such as caring responsibilities, isolation, bereavement and a whole host of other factors that shape our complex lives. Having community groups and wider well-being services present also meant that most of those factors could begin to be addressed immediately by introducing a CAD participant to an appropriate support network or provider.
A whole range of other factors were brought into play to ‘de-medicalise’ the CAD and make sure that anyone who attended was genuinely listened to and understood as a whole person rather than as a patient presenting a medical condition. Innovations included having no time limit on conversations and encouraging the participants rather than the clinicians to keep notes of those conversations. Without that approach, the CAD would clearly not have been able to offer the degree of personalised and immediate support that allowed people to be taken off and to stay off the waiting list while also receiving much more considered and sophisticated care.
Further CADs are now planned for later this year and New Local will be attending and reporting back on how lessons from the first CAD have been applied. We’re particularly excited about this initiative because it shows that community powered and strengths-based approaches can have an impact on short term as well as longer term demand. It’s also exciting because it seems highly likely that the approach could be applied beyond the MSK specialism to a much wider range of health and social care areas.
This short blog can only give a sense of the CAD, so do listen to my interview with Laura and her colleague Natalie Blunt, the Managing Director of Sussex MSK Partnership, to get much more detail on the thinking and preparation that went into the initiative.
I’m also interested to hear of other initiatives that have used community power or strengths-based approaches to address short term demand. Equally, if you’d like a chat about the CADs and want to know more or are thinking you might want to trial a CAD in your area, do get in touch.
“We’re not going to get out of this situation with increased efficiency… The Community Appointment Days were a real shake up of the system.”
Natalie: “We had created a highly efficient, but highly industrialised healthcare process with MSK. I’m from an operational background, I feel like I’ve spent decades working towards efficiency in processes and just suddenly realising: that is not what we need here. We’re not going to get out of this situation with increased efficiency.
“MSK is hugely prevalent within primary care. It’s one in five, one in four, one in three, depending on what statistics you read, in terms of primary care visits. We just saw this as an opportunity to start to influence the care journeys of a huge swathe of the population that we serve. If we move beyond their toe or their knee into something which says actually how can we look at the health and wellbeing of that person in totality.
“The Community Appointment Days were a real shake up of the system. Saying, this isn’t just about copying and pasting what you do in clinic into a leisure setting. If people go away and do that, as a result of all of this, then we’ve fundamentally not delivered what we said we would do. It’s about really changing those models of care, really enabling people to step out of the passivity of being a patient and into something which is much more befitting with who you are and all of your other elements of your life.
“On the CAD, more than 50% of people had one contact with our service that day, and have not needed anything ever since.”
“Reducing the waiting list greases the wheels, but it’s not the final destination.”
Laura: “I think signposting is really problematic because often people choose not to go because it’s too difficult. And so one of the things we really focused on was, let’s have those community services in the room and then they’re accessible. That What Matters to You conversation was critical in drilling down into what did they need. And if that was support from the community services, then here it is.
We had a raft of community services. And what we found was there were around 30% of the people who came for the day either had a conversation or an intervention from the local services,.
Adam: And what was the impact on the waiting list?
Laura: The waiting list did reduce. We were at 16 weeks and it went down to 11 weeks.
But I think the key thing is this wasn’t set up as a waiting list initiative. Reducing the waiting list greases the wheels, but it’s not the final destination. That wasn’t our focus. Our focus was about supporting people beyond their MSK condition. Really enabling them to support themselves in that journey but also, giving our staff some respite from that treadmill.
“It was really a light bulb moment for me.”On New Local’s NHS report
Natalie: I remember Laura sent [New Local’s Community-Powered NHS report] to me and both our eyes lit up. It’s resonated and furthered our thinking. I noticed even when we were coming up with concepts at a later point in the process we almost used it as a benchmark. It became quite a helpful yardstick of saying, Does it really meet what we’ve been inspired by? Because if we read this in six months and someone else isn’t inspired by what we’ve done, then we’ve not achieved what we set out to do.
Laura: I read that and I was so energised. I said, Nat have you read this? Because we should be doing this. I know it’s got nothing to do with MSK, but it has everything to do with it. It was really a kind of light bulb moment for me.
Laura Finucane explains the idea behind the Community Appointment Day and how it worked
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