My experience in secondary care rheumatology is essential for my role as a First Contact Physiotherapist (FCP). As ‘gatekeepers’ to the healthcare system for MSK complaints, FCPs have an opportunity to recognise Rheumatic conditions; screen and promptly identify disease characteristics; and refer early into secondary care. Additionally, being in this role has allowed me to use my knowledge and special interest to support in the primary care multi-disciplinary team in their Rheumatology education.
Usually the FCP role involves patients attending the general practice surgery, following telephone triage directly onto the FCP list, and subsequently being assessed face-to-face to receive diagnosis, treatment and management of their condition. However, healthcare in primary care was beginning to change even before the unwelcomed arrival of the novel coronavirus 2019 (COVID-19). The NHS Long Term Plan commits that every patient will have the right to be offered virtual care or ‘digital-first primary care’ by 2023-24. Virtual care is remote access to health-related services and information with the use of technology solutions.
‘Digital technology is transforming how patients and health professionals interact. Moving [primary care] towards a digital first approach, where patients can easily access the advice, support and treatment they need using digital and online tools.’ NHS England.
Due to the COVID-19 pandemic, there has been a rapid adoption of new virtual ways of working and providing healthcare, as with all healthcare services. What would have perhaps taken many months and years of consideration, trouble shooting and system wide policy discussions, has been achieved in a matter of weeks in some cases. Less of an upheaval than was expected, local Physiotherapy networks within the South West of England, linked through their Chartered Society of Physiotherapy forums, have connected to help share and spread ideas and best practice during these challenging times.
Like many other colleagues, I have found that my role has changed and am now working largely from home by completing telephone and video consultations with patients. I also provides cover on the urgent MSK list, where face-to-face appointments are made available for those patients who are clinically reasoned to be in need of fast and perhaps frequent interventions, such as post-surgery, post-fracture or certain neuro-musculoskeletal presentations. Many of my colleagues in the community Physiotherapy outpatient service have been redeployed to community re-ablement and respiratory outreach services to support in the battle against COVID19.
Whilst everyone is working hard during this time, it is always important to remind ourselves to focus on us, the practitioner, as well as the patients. Maintaining our own self-care and well-being will be for the benefit of us, our families and our patients. In April 2020, NHS England launched a mental health hotline as part of a package of measures to support the NHS’ 1.4 million staff as they help people deal with the coronavirus. In addition to this, the NHS shares more well-being advice for people seeking to improve their mental health and well-being, outlining 5 steps:
There remain many unknowns about the virus and about what the coming months will look like. Throughout healthcare, academia and the political spheres, this pandemic has left a vast amount of uncertainty in its wake when one thinks about the future, and for us, about Rheumatology medicine. With a ‘second wave’ of the virus anticipated, it is likely that virtual care will be the ‘new normal’ for some time. The Physiotherapy team in Bath and North East Somerset has shown that it can be flexible and adapt within challenging times, similar to many healthcare services facing these unprecedented times.
We are all in this together.