Chief Allied Health Professions Officer’s Conference 2016 Workshop 5: Population based service re-design – Chair Shelagh Morris Embedding a health promotion strategy across MSK physiotherapy services in Salford. Gillian Rawlinson, MSK Advanced Practitioner and Senior Lecturer. Salford and UCLAN

1. Embedding a Health Promotion
Strategy across MSK
physiotherapy services in Salford
Gillian Rawlinson
Advanced MSK Physiotherapy Practitioner
Salford Royal NHS Trust
(Senior Lecturer Physiotherapy, University of Central
Lancashire )

2. What was the problem?
• Salford has some of the worst health in the country
and large health inequalities.
• AHP’s being urged to optimise Public health
interventions.
• Many MSK problems are influenced by health and
lifestyle choices e.g. weight, physical activity,
smoking, mental health issues e.g. OA, LBP,
tendinopathies etc. (NICE 2014, Tilley et al 2015, Ranger et al 2015)
• Physiotherapy undergraduate education leading
and developing public health practice yet not
always modelled in practice.
• Public health practice on physio practice was sub
optimal, patchy and not seen as a priority.

3. Management of OA (NICE 2014)

4. So what did I do?
• Spoke to my manager with passion and
enthusiasm for change and identified
key drivers.
• Suggested seeking funding to ‘do it
properly’
• Spoke to innovation fund lead at Salford
CCG, armed with facts and passionate
about what and why we need to change.

5. Next steps…
• What did I want to achieve, what was the
vision?
• What were the drivers behind this change?
• Where were we at?
• How could we measure impact and
demonstrate change?
• What did I require to achieve this vision?
• How could this change be sustainable and
how could we share good practice ?

6. Why?
(NHS England, 2014)(AHPF, 2015)
(PHE 2015)

7. So what happened next?
• Developed and wrote bid with guidance
from commissioners, they were very
supportive and friendly!
• Got £21,000 to fund myself (0.2 WTE
for 6 months) and a Band 2 (0.5WTE for
1 yr) plus funding plus for equipment
scales, leaflet racks etc.
• Funds rental of health data machine at
one site for year as pilot .

8. Our Vision
1. All patients will be given the opportunity to discuss their lifestyle
factors in a supportive environment focussed on improving their
overall health and wellbeing.
2. All patients will have their basic health data collected, recorded
and communicated to GP (height/ weight/ BMI) .
3. The team will take every opportunity to support and foster a
positive culture of embedding health promotion in everything we
do.
4. We will work together with our partners in the trust, community
and voluntary organisations to facilitate seamless transfer of care
and access to all health promoting services.

9. What to measure?
• Record Number of healthy conversations
and content
• Record BMI data for all patients
• Record number of onward referrals to
health promoting services
• Evaluate staff knowledge and attitudes
towards health promotion .
• Case studies to identify impact

10. Results and evaluation.
Key Objectives
1. 80% of patients who are attending for an appointment will have BMI
/ BP data recorded in their physiotherapy health record (and
communicated with GP on discharge).
2. 80% of consultations will have an appropriate and meaningful
healthy conversation recorded in their physiotherapy record.
3. Establish and maintain firm partnerships with trust departments,
and health promoting community and voluntary organisations.
4. Increase appropriate referrals to other agencies e.g. smoking
cessation/ active lifestyles team, weight management services by
100%.
5. Service staff will have an increased in positive attitudes towards
embedding a health promotion strategy within MSK/ CATS services.

11. Baseline evaluation (n= 70) Physiotherapy and
CATS records (bands 5-8b) across geographical
sites from Jan 2016.
0
10
20
30
40
50
60
70
80
physical
activity/
hobbies
smoking alcohol conversation
about wt
management
osteoporosis referral to
community
health
promotion
service
Documented information in Physiotherapy
records relating to lifestyles and health
behaviours and referrals
recorded not recorded

12. The story so far…
• Baseline data collected
• Outline of services developed
• Met with all key partners and stakeholders to identify
services, referral pathways and develop partnerships
• Discussion with senior Trust executives re
development of Trust wide health promotion strategy
• Alignment with Salford's National Diabetes Prevention
programme (NDPP) / identifying those with IGR pre -
surgery
• Liaison with PH commissioners re ‘health check’
provision
• Plan to; Launch’ project with staff including training
and support

13. BMI/ BP Machines

14. Its growing!....
Embedding a
Culture of Health
promotion
Healthy
cubicles/
environment
Building
partnerships
across trust
and third
sector
Changing EPR
documentation
to demonstrate
impact
Staff training
and leadership
Links with
National
Diabetes
prevention
programme
Collection
health data
/Health checks

15. Top Tips!
• Your enthusiasm and passion for change is the
critical factor that will keep you going!
• Don’t accept No for an answer, go to the top!
• Do your research about why need change/
innovation
• Pick up the phone and talk to your commissioners
• Think about measurement and use your relevant
departments to support you.
• Network and share what’s happening to grow and
develop ideas.

16. Thank you ! @GillRPhysio

17. References
Ranger TA, Wong AMY, Cook JL, et al. (2015) Is there an association between
tendinopathy and diabetes mellitus? A systematic review with meta-analysis. Br J
Sports Med.;0:1-10.
Tilley BJ, Cook JL, Docking SI, et al. (2015) Is higher serum cholesterol associated
with altered tendon structure or tendon pain? A systematic review. Br J Sports Med.
NICE (2014) Guidelines for Care and Management of Osteoarthritis; ;London CG177
Allied Health Professionals (AHP) Federation (2015). A strategy to develop the
capacity, Impact and Profile of AHP’s in Public health 2015-2018
http://www.ahpf.org.uk/files/AHP%20Public%20Health%20Strategy.pdf
NHS England, Care Quality Commission (2014) NHS Five year forward view ;
London; NHS England
Public Health England (2015) Health Profile for Salford; London; PHE;
http://www.apho.org.uk/resource/item.aspx?RID=171633