01.06.15
Demonisation of the private provider: the MSK physiotherapist perspective
Source: NHE May/June 15
David Pearce, EKTRA Ltd principal physiotherapist and company director, discusses the commissioning of musculoskeletal (MSK) physiotherapy and its outstanding improvement to patient care.
Following 18 months, after thousands of amendments, the Health and Social Care Bill was passed in Parliament in March 2012; the writing was on the wall for NHS providers and staff to either embrace the changes or disappear. In East Kent, GPs, commissioners and independent providers embraced the changes and became the pathfinders for the development of GP-commissioner-led services, delivered to key performance indicators that would provide safe, value for money, efficient, high-quality physical therapy services
Working as the superintendent physiotherapist for the Canterbury and Coastal area gave me insight into a failing NHS Physiotherapy service: new to follow-up (NFU) ratios were climbing, ‘did not attend’ (DNA) rates were as high as 20% and waiting times even reached a maximum of 53 weeks for routine chronic conditions.
In partnership with local GPs and practice-based commissioners, EKTRA was established in 2007 with the prime objective of tackling the deplorable above-mentioned problems in East Kent NHS Physiotherapy services. An independent contracted service was commissioned by the NHS and produced a truly efficient and seamless service for its patients. The independent management of patient referrals allowed for patient choice and expansion of service availability, delivered from a plurality of providers.
Where patients were previously being funnelled into secondary and primary care physio centres, and hitting bottlenecks of high waiting times, they are now allowed to choose to have their physio in their GP surgery near home, or their workplace, or even in one of EKTRA’s six private clinics. NHS patients can now experience the quality, integrity and care of real private healthcare, without the worry of having to find the funds to pay. This is what is commonly referred to in the media as ‘privatisation of the NHS’.
With this phrase, media outlets and politicians have incited a belief and scared off the public, reminding them of past problems experienced with privatisation within the public sector and grossly expensive PFI (private finance initiative) deals. Ultimately, they have demonised the private companies as ‘fat cats’ creaming off the profits.
Sadly, we’re not shown the full picture. Providing a contract for companies like EKTRA is similar to finding a decorator to rejuvenate your house: you tell them what you want, they do what you want. You don’t worry about when you’re going to decorate, the materials you will need, the planning and execution of the process. This method is tried and tested in all walks of life, yet we seem more reluctant implementing this in our health service. This aspect of NHS service is not being ‘privatised’; there is no selling off or ownership of the NHS. EKTRA and other providers must provide the service to agreed NHS standards or they will fail and disappear quickly. The contracts are zero-based in value; they cost nothing to the NHS when not providing treatments or for failed appointments, downtime or peaks and troughs in demand. This ultimately results in highly efficient, cost-effective and value-for-money patient care. The private sector is only providing what the NHS has failed to do and has not been able to provide within its capacity. Therefore, the demand has grossly exceeded supply!
Over eight years, EKTRA has seen its physical therapy services bring DNA rates down to 4.98% and the NFU ratio to 1:3.35. Waiting times are massively reduced, with appointments booked for within one week and urgent cases within 48 hours. This is a startling improvement on the historical average NHS wait of 12-plus weeks.
Numbers and statistics have become a very important element of controlling overstretched and under-resourced services. However, patient care is paramount, as each single patient referral is the most important asset to EKTRA, a growing healthcare company.
The local CCGs benefit from our services as it reduces their financial burden by decreasing secondary care referrals, and their prescribing and administrative costs. The service provides real-time records with flawless communication between GP/physiotherapist and the patient. Both GPs and physiotherapists have a “sense of ownership and control over the service”. Equally, physiotherapists are empowered and supported to work autonomously with flexible working patterns, according to demand. If you want to provide a first class community-based service that could be recommended to your friends and family then this is the business model to follow. It works.
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