Physiotherapy and occupational health

The occupational health and physiotherapy services of Doncaster and Bassetlaw Hospitals NHS Trust worked together to develop a physiotherapy function dedicated to occupational health. The services was developed to reduce the level of musculoskeletal morbidity and related sickness absence amongst staff of the trust; and to provide pro-active management of musculoskeletal problems and leadership on musculoskeletal issues.

The organisation

Doncaster and Bassetlaw Hospitals NHS Foundation Trust employs 6000 staff who are based on five separate hospital sites. The trust provides services to a population of 410,000.

SHA region

NHS Yorkshire and the Humber

Project dates

March 2005 - to date

Project background

Doncaster and Bassetlaw Hospitals NHS Trust had higher than average sickness absence. Musculoskeletal problems were one of the two main causes. Occupational health advisors often found that employees off work with musculoskeletal problems, had not been referred to a physiotherapist by their GP for management of those problems, or they were still waiting to receive an appointment. There was no pro-active musculoskeletal intervention designed to support employees in work and prevent absence.

To speed access to physiotherapy assessment and management of these problems, the trust funded a pilot occupational health physiotherapy (OHP) service. The pilot evaluated successfully and the service is now a key part of the trust's occupational health service and sickness management strategy.

What we were trying to achieve and how

It was proposed that reducing access times to physiotherapy service should reduce the number of sick days lost due to musculoskeletal disorders. Also, by working closely with occupational health and human resource colleagues it would continue to improve sickness management across the organisation.

The service is run by a full-time Band 7 clinical specialist physiotherapist employed by physiotherapy. A 0.3 Whole Time Equivalent (WTE) Band 6 physiotherapist runs a satellite service and a 0.5 WTE Band 2 administrator supports the service.

Employees access the service either by self-referral or from a referral by occupational health staff, GPs or consultants. Problems may be work-related, or non-work related; acute or chronic.

Musculoskeletal physiotherapy services in the area are largely delivered in primary care locations, so having an on-site service for staff minimises time away from work and improves access.

What was the result

There was an immediate take up of the service with an average of 64 referrals per month, representing 12 per cent of the trust's workforce:

• eighteen per cent of referrals were by occupational health staff
• sixty-seven per cent were self-referrals
• fifteen per cent came from GPs or consultants.

Of those using the service:

• Sixty-five per cent said that it saved them taking some sick leave. If the saving was a minimum of one day of sick leave, this represents a saving on investment of 1:1. If in each case a period of self-certification was averted then the saving over investment represents 5:1.
• Eighty-six per cent stated that they were able to return to work sooner.
• Eight-eight per cent stated that it saved a visit to their GP.

Analysis of data also revealed areas of concern for musculoskeletal problems and injuries. This has led to focused ergonomic and training interventions in those parts of the organisation. Data also revealed that musculoskeletal disorder was common amongst certain staff groups. These groups have been targeted with preventive health education.

By basing the physiotherapists within occupational health they are available as a resource to give advice to the occupational health team, who in turn are more informed and effective in supporting staff to remain at work and in managing musculoskeletal related sickness absence.

Speed of access is important and the service is generally available within five working days. Urgent 'on the day' access often enables staff to remain in work rather than moving into sick leave.

Self-referral enables staff with either acute or long-term conditions, whether they are work-related or not, to access the service when they need it, reducing the musculoskeletal burden and improving health and performance.

Tips for other trusts

• collect robust data to demonstrate the obvious saving on investment to purchasers
• publicise and explain the service well to employees, managers, and gps in the area to ensure rapid referral for trust employees
• allow self-referral to be effectively pro-active and preventive
• use a bio-psychosocial approach, with emphasis on movement, postural training and task design to prevent work related activities causing or aggravating musculoskeletal problems
• provide access to rehabilitation facilities for some cases.

Further information

• Merrin Froggett, Clinical Specialist Physiotherapist - Merrin.froggett@dbh.nhs.uk
• Amanda Espey, Head of Physiotherapy Services - Amanda.espey@nhs.net
• Debbie O'Toole, Occupational Health Service Manager - Debbie.otoole@dbh.nhs.uk