An integrated community team works with the London ambulance service: perspectives on the emerging role of physiotherapists in pre-hospital care

Abstract

Background: The UK National Health Service’s (NHS) initiative to move more care to the community in order to provide quality and cost-effective intervention has been a key focus of its strategy for over a decade. This has seen the establishment of the integrated community multidisciplinary team (MDT) and the development of further emerging roles for allied health professionals (AHP). Specifically, extended scope physiotherapists (ESP) are now playing active roles as members and leaders of MDTs in emergency, pre-hospital and urgent care settings. Purpose: A new care pathway was established in June 2014 between the London Ambulance Service (LAS) and the Integrated Community Response Service (ICRS) in North West London. It was set up with the philosophy that integrated care teams with enhanced clinical training should be able to successfully manage appropriate acute (but not immediately life-threatening) LAS cases in the community. Methods: Clinical members of the ICRS spent observation days with the LAS and discussions between members took place before ‘going live’ with the pathway. Regular meetings continue to be held with the LAS as part of its ongoing development.Within the system, referrals are received via telephone and discussed with the daily clinical coordinator to determine appropriateness. The ICRS receives referrals 7 days a week between 7 am and 7 pm. Once the referral is accepted, the ICRS responds accordingly within a 2-hour window and provides clinical intervention and management for approximately 7 days. The number of referrals received between June and September 2014 were collected and analysed. The reason for referral, the team members involved, the interventions and the overall outcome of each case were recorded. Results: The number of referrals received from the LAS between June and September 2014 increased by 100%. All patients referred by the LAS and accepted by the ICRS were subsequently assessed and managed in the community by the ICRS clinicians. Inappropriate referrals were declined verbally on the phone. Considering specific case examples, the physiotherapist demonstrated autonomy in assessment, intervention and case management. Conclusion(s): An appropriate LAS case can be referred to an integrated community MDT and managed accordingly. Each patient accepted by the ICRS received interventions from at least three members of the MDT and therefore the direct impact of the physiotherapist alone is unknown. The LAS and the ICRS have successfully demonstrated that they can collaboratively work together in managing acute patients in the community in North West London. Implications: There is an emerging role for physiotherapists in emergency, urgent and pre-hospital care and in response to an appropriate LAS referral. Further research is required into emerging physiotherapy roles. Consideration of merging roles, scope of practice, educational programs and health economics is also required.