Abstract

Changes in professional boundaries have allowed many of the tasks traditionally undertaken by doctors to be delegated to Nurses and Allied Health professionals. The employment of an appropriately experienced specialist physiotherapist in orthopaedic clinics in the NHS to triage patients is well established. This paper examines the background, establishment and outcomes of the use of a Physiotherapist Extended Scope Practitioner (ESP) in the Orthopaedic Department at the Royal Hospital Haslar, Gosport. The ESP post at RH Haslar has evolved in the five years since its implementation in 2000. All military patients referred to RH Haslar Orthopaedic Department with spinal, predominantly low back, pain are assessed in the Military Spinal Triage Clinic. The Physiotherapist ESP case-manages patients with access to radiological and haematological investigations and onward referral to other specialities as appropriate. Between July 2003 and December 2004, 235 new patients were assessed. Only 25 patients required review by the consultant spinal surgeon and 5 were referred to non-spinal orthopaedic consultants with shoulder/hip pathology. A total of 18 patients were referred to Pain Clinic and 3 patients to Rheumatology, indicating that nearly 90% (n=210) of patients who would previously have been reviewed by a consultant spinal surgeon could be managed by a Physiotherapist ESP. The waiting time to spinal surgery has reduced from approximately 8 months to between 6 and 16 weeks. An appropriately trained specialist physiotherapist is clinically and economically appropriate to manage patients in an Orthopaedic Department. This has important implications for optimising patient management and additionally supports the wider clinical employment of senior military physiotherapists.