Quality Assured Clinic

How do part-time subscribers participate in Data for Impact and Quality Assured Clinic?

Part-time subscribers will have to join Physio First by going through our join online application, click here.

Once confirmation has been sent to you via email from Physio First that you are a part-time subscriber of Physio First then please follow the next steps:

  • You will need to sign up to Data for Impact using the UoB application process, click here 
  • Once confirmation has come through from the UoB that your application has been successful then you will begin inputting data.

If your practice principal wishes to apply for QAC status, then they will apply to the UoB who will send a delaration to the practice principal who will confirm your part time working hours to the UoB.

If you join Physio First as a part-time subscriber, the initial cost is £143

This is made up of:

  • £23 for March - March 2019/19 +
  • £120 for 2019/20 subscription

[Reviewed - March 2019]

How is part-time subscription defined?

A part-time subscription level has been created for private physiotherapists that work 20 hours or less and work for a clinic working towards Quality Assured Clinic (QAC) status by collecting data on all their new patients where possible. This new part-time subscriber category allows part time colleagues to pay a proportionally lower subscription rate and allow them to participate in a QAC status.

To apply for this rate, your practice must confirm in writing that you meet the definition of a part-time subscriber, and you work 20 hours or less per week. You must also begin to collect patient outcome data on Data for Impact (DfI) and be collecting PROMs within one calendar month of joining Physio First. Part-time subscription is not available to practice principals, sole practitioners or those who are not participating in DfI.

When joining Physio First as a part-time subscriber you will be asked to input the number of hours you work through our join online application.

Private physiotherapists who work alone or are the practice principal and have a stake in the business then you are not eligible for part-time subscription.

[Reviewed - March 2019]

How do I join under the part-time subscription?

Part-time subscriptions

  • Go to join online - https://www.physiofirst.org.uk/join.html
  • Complete step 1 all the way through to our privacy policy and payment screens
  • You will be sent a confirmation email which will confirm you have joined Physio First as a part-time subscriber
  • We will send you details on how to sign up to Data for Impact (which you must do within 1 calendar month from joining to obtain your part-time subscription)

If you work alone or are the practice principal you are not eligible for part-time subscription.

Introducing part-time subscriptions for Quality Assured Clinics

  • When we first started exploring Quality Assured Clinic status we realised that a very important section of our industry would miss out on QAC status unless we created a new subscription category to allow for those working part time. Many clinics rely on part time staff and we felt it was only fair to make the scheme as open to them as possible.
  • A part-time subscription level has been created for private physiotherapists that work 20 hours or less and work for a clinic working towards QAC status by collecting data on all their new patients where possible. This new part-time subscriber category allows part time colleagues to pay a proportionally lower subscription rate and allow them to participate in Quality Assured Clinic.
  • To apply for this rate your practice principal must confirm in writing that you meet the definition of a part-time subscriber, and you work 20hrs or less per week. You must also begin to collect patient outcome data on Data for Impact and be collecting PROM’s within 1 calendar month of joining Physio First. Part-time subscription is not available to practice principals, or those who are not participating in Data for Impact.
  • We have also created an ‘on hold’ subscription category for MSK clinicians who are on maternity leave, or absent from work in clinics working towards QAC status. This allows clinics who have absent staff during the data collection period to still take part. If the staff member returns within the next measuring period they will be required to become a member, or part-time subscriber, before the clinic can be measured again and gain or regain their QAC status.

[Reviewed - March 2019]

How does my practice become a Physio First Quality Assured Clinic?

To become a QAC you and your MSK colleagues will need to continue inputting your data if you are already doing so or start now. Our University of Brighton team will download your data and will confirm those clinics to be awarded via email. Data downloads and QAC assessments will run alongside QAP assessments in January, May and September.

Here’s the criteria for becoming a QAC:

  • All clinic staff must be collecting their patient data through Data for Impact. To do this, each team member will receive their own login, username and password and will also be collecting PROMs.
  • All clinic MSK practitioners must be Physio First members or part-time subscribers, no matter their employment status – self-employed associate or employee (Part-time subscription is not available to practice principals, or those who are not participating in DfI). If you have any full time physiotherapists that need to join, you can benefit from significant discounts via Refer a Colleague (Our Refer a Colleague scheme is not open for part-time subscribers, please see our T&Cs here).
  • This is open to all clinics of any size, from single-practitioner clinics to multi-practices.
  • If you have part-time colleagues they can still participate through our new part-time subscription. They will be assessed on a pro-rata basis based on the number of hours they work.

Clinics will have their individual data amalgamated into one clinic report once consent is obtained from each participant. Only the practice principal will receive the clinic report. Individual participants who are also QAPs will have their own individual reports which can be used for CPD and peer review purposes.

[Reviewed - March 2019]

How do I, as a practice principal, apply for QAC status?

You need to apply to the University of Brighton, who will send you a declaration form where you enter all the names of your MSK practitioners and the number of hours they work.

The University will then contact each practitioner, who must be actively participating in Data for Impact, to obtain their consent to amalgamate all of their data into your clinic report.

This report will then be tested against the criteria agreed between the University and Physio First and if you reach or are above the baseline then your clinic will be awarded Quality Assured Clinic status for the following twelve months.

[Reviewed - March 2019]

What if all my practitioners are not treating MSK patients

This is fine you will not need to add them to your declaration as their data will obviously not be able to be entered into the DfI tool as this is for MSK patients only at present.

[Reviewed – March 2019]

I am a single-handed practitioner, can I apply for QAC status?

Yes, the only additional requirements over QAP status is a declaration by you to confirm that you are the only MSK physiotherapist in your practice. So, you need to:

  • Contact the University of Brighton who will send you a declaration form which you need to complete to confirm that you are the only MSK physio in your clinic
  • Have collected 50+ discharged datasets within 12 months
  • Be collecting PROMs
  • Reach criterion testing – for details please click here to read our FAQ ‘Which parts of our analysed data make up the Physio First QAP baseline?’ - see here

[Reviewed - March 2019]

I am a single-handed practitioner and a QAP, can I apply for QAC status?

If your QAP status was awarded in the past 12 months and you are collecting PROMs then you can apply for QAC status, for the duration of your current QAP award. You simply have to contact the UoB at this email address physiosurvey@brighton.ac.uk and complete the declaration form confirming that you are the only MSK physiotherapist in your clinic.

[Reviewed - March 2019]

How will I receive clinic reports?

You will have to apply to UoB who will amalgamate all the data from your clinic, once permission is obtained from your practitioners and there is sufficient data, the University will then pass the report to you as practice principal.

[Reviewed - March 2019]

I'm a practice principal how do I confirm the part time status of a member of my team, what do I do?

Annually sign a declaration sent to you by UoB, on application, stating the number of MSK staff in your clinic and providing the UoB with the number of hours they work a week when you apply for testing.

[Reviewed - March 2019]

What is an on hold membership subscription?

Physio First's membership is split into different membership categories; Full, Affiliate, Non-practising and Honorary life.

Within our Constitution, (click here to read) under point 4.3 Non-practising membership is stated as "Non-practising membership shall be open to those Chartered Physiotherapists who have previously held Full Physio First membership but who are currently not practising as a physiotherapist at all".

This membership lasts for a maximum of 2 years for an annual price of £40 (rates at 2018).

Below are some examples as to why you may wish to convert to Non-practising:

  • Maternity leave
  • On a break from practising
  • Personal reasons
  • Long term illness
  • Any reason that may prevent you from practising.

How to put your data on hold

To put your membership on hold please contact Physio First by emailing us at minerva@physiofirst.org.uk

If you are collecting data via our Data for Impact project, your data can also be put on hold by contacting UoB by emailing them on physiosurvey@brighton.ac.uk

What to do when returning back to work

When you have returned to work and practising fully you can then convert back to Full membership or part-time subscriber and start collecting data.

[Reviewed - March 2019]

Do I receive a certificate and special QAC logo?

The clinic will receive a certificate and QAC logo which will be sent by Physio First and the practice principal will receive this.

Once data has been extracted and tested the UoB will send through a clinic report to your practice principal, if you have been successful in testing you will have to send through the email you get to minerva@physiofirst.org.uk

[Reviewed - March 2019]

How often will my clinic be re-assessed?

Your QAC status lasts for a 12-month period. Once this is due to expire you will need to apply to UoB for retesting at the next download of data. QAC testing   runs alongside our QAP testing  from data downloads  in January, May and September each year if your clinic has collected sufficient data sets in the past 12 months and are collecting PROMs.

[Reviewed - March 2019]

What is the assessment process for QAC status?

QAC data requirements

Practitioners should aim to collect data on all new MSK patients. Minimum data requirements have been agreed to minimise error and help ensure that the data submitted is reflective of a practitioner’s work load and the clinic. The agreed minimum data requirement for the QAC scheme are:

Sole practitioners:

  • Require a minimum of 50 discharged data sets in the past twelve months

Clinics with multiple practitioners:

  • Full-time practitioners require a minimum of 50 discharged data in the last 12 months. The minimum data requirements for part-time practitioners will be proportionate to their hours worked (i.e. their FTE status x 50 discharged data sets) please see Table 1*  
  • Practitioners who are new to the DfI study (i.e. those who have joined within the last four months) will have no minimum data requirements providing that the percentage of new practitioners in the clinic does not exceed 20%**

 *Clinics with multiple practitioners require a minimum of 50 discharged data sets in the past 12 months in order to be eligible for QAC assessment. 

**Please note that the although eligible for QAC assessment, the data submitted by practitioners who are new to the DfI study (i.e. those who have joined within the last four months) will only be included into the data analysis if they meet the minimum data requirements (their FTE status x 50 discharged data sets).

Table 1.  Minimum data requirements for the QAC assessment for part-time practitioners

QAC analysis

The following approach will be used to calculate a clinic’s score in relation to each of the criterion:

  • Firstly, an average of each of the practitioner’s data will be calculated.
  • Secondly, each of the practitioners scores will be weighted according to their FTE status.  This approach will ensure that the clinic’s score is representative of their treatment provided to patients in that clinic.
  • Calculations for QAC criteria will be based on the benchmarks set for the QAP assessment.  This will ensure consistency between the two schemes. See our FAQ ‘Which parts of our analysed data make up the Physio First QAP baseline?’ – click here

[Reviewed - March 2019]

 

QAP Scheme

What were the findings from Physio First’s attendance at the fourth Quality in MSK working group meeting held on 18 July 2017?

In our October 2017 edition of The Core we discussed how our attendance at the fourth and final Quality in MSK working group meeting help us reach our most important realisation. Our own QAP scheme is, in fact, a PROM! A realisation that makes talking about our QAP and QAC schemes in the healthcare marketplace, so much easier. 

Other highlighted information from this meeting included:

  • It would be unrealistic to expect healthcare providers to adopt one universal data collection scheme and thus marketplace stakeholders will develop their own. That said data collection schemes by themselves are absolutely not the same as quality assured schemes, although they are a pre-requisite.
  • Data collection schemes will be capable of being ranked – from those that just collect data, to those that collect validated data, to those that do so through an independent third party, to those that both collect data and have it analysed by an independent third party. In such ranking our Physio First QAP and QAC schemes will come very high.
  • There will be no sector-wide consensus on diagnostic coding. All existing diagnostic coding from OSICS to ICD9 or 10, including the validated diagnostic coding within our QAP and QAC schemes, will be capable of mapping to others, when (and if) the need arises.
  • The working group agreed that SNOMED (see here) could be the most likely candidate to have other diagnostic coding mapped to it, but all agreed that it is not embedded enough for that suggestion to be at all certain.
  • It was felt that the Private Health Information Network (PHIN; see here) would eventually become responsible for mandating data collection within private MSK treatment, as it currently does this for private hospitals, consultants and insurers. This won’t be for some considerable time due to the volume of their current work.
  • Before PHIN takes over, measurement of quality will first be resolved by the marketplace. Again, our QAP and QAC schemes looks an excellent candidate to resolve quality in private MSK physiotherapy as long as we (Physio First) do not become complacent.
  • Initially, the first steps towards assessing quality in MSK treatment will occur in the non-surgical therapies, i.e. physiotherapy, osteopathy and chiropractic as, to try to introduce it into an MSK pathway that includes surgery is too complex at this time.
  • The introduction of quality to MSK treatment providers is just as necessary as the introduction of quality to insurers. Private medical insurers are themselves in a race to differentiate and compete on quality with their own services and products. Physio First can help them do this, but only if we can establish a new kind of relationship between the insurer and private physio which, thanks to our QAP scheme, is now a possibility.
  • Robust data collection schemes will be able to identify providers who fabricate data from the analyses of the data itself. This is reassuring, and a premise that we are already working on with our University of Brighton team.

[Reviewed - September 2018]

Did Physio First develop our QAP scheme for insurers or commercial intermediaries?

On both counts the answer is absolutely not!

Before we get into the meat of the answer to this question it is important to remember who Physio First is i.e. we are an organisation of self-employed private physiotherapists that are run by volunteer colleagues. Our ethos, as has been articulated many times since 2013, is not to work “for” members but to work “with” members.

The easiest way of describing what this latter point means is that for Physio First to continue to attract volunteers we had to become an organisation of colleagues “working together”.

So, with this background in mind, it is important to remember that every Physio First volunteer (with the sole exception of one) is a self-employed private physio who has experienced much the same as most other members to include that of feeling disrespected by private medical insurers and even more so by commercial intermediaries.

So, to answer the question – Did Physio First develop our QAP scheme for insurers or commercial intermediaries? Physio First did NOT develop our QAP scheme for insurers or commercial intermediaries! We developed it due to long deliberation upon the question “how do we empower Physio First members in the changing healthcare marketplace?

In an attempt to summarise these long deliberations, we would add:

  • The world and our marketplace is changing, which means that we have to adapt as well
  • In most of the discussions that our representatives have had with marketplace stakeholders, from Physio First members themselves, to the CSP, to forecasters, to private medical insurers and commercial intermediaries, to our interaction with overseas private physio organisations (commercial as well as professional) the inexorable move is towards all marketplaces demanding some validated measure of quality in healthcare
  • It has happened in other sectors e.g. we, as individuals, routinely go on-line to gauge the quality of a product or service – for a service this often means searching consumer blogs or websites like TripAdvisor
  • Following all of this, it is our judgment that “if” Physio First does not take a lead in this then some other marketplace stakeholder will which would inevitably come in the form of:

So, all of these sorts of deliberations combined with the fact that through annual funding from the charity PPEF, massive support from Physio First volunteers and members alike and a contract with our dedicated University of Brighton team, as Physio First we have been collecting and developing the process for collecting and analysing standardised data since 2005.

In all that time we had developed not only expertise in standardised data collection (through an academically validated tool), but in its interpretation and in its publication. Just look at the reports that, as Physio First, we have published with the University of Brighton over the years, to view please click here - note you will have to log in as a member to view these.

What these published reports told us was that, as self-employed private physios, the analysed data really does demonstrate that we are genuinely as good as we think we are.

So, with all of this as the background, our Quality Assured Practitioner scheme became an obvious thing to develop. A tool that would enable any member who wants to, to demonstrate, with the full backing of a highly regarded academic institution, a means of being able to say “I am a quality assured practitioner and I can demonstrate that I am!”

It is also a quality assured standard that we, as self-employed private physios, own and control as Physio First. Something that many of the marketplace stakeholders really dislike!

So back to the question - Did Physio First develop our QAP scheme for insurers or commercial intermediaries?

The answer is quite the reverse. We developed it to avoid Physio First members from having to jump to “quality standards” that inevitably would be imposed upon us.

So, there is no chance of Physio First, who you will remember is run by colleague self-employed private physios, of selling our QAP scheme or mortgaging it, or in any way “giving it” to organisations that we do not regard as strategically or culturally aligned to Physio First. It is there for us, as members, to use in our marketplace to set ourselves apart from others who do not (perhaps cannot) reach these levels – or even to set ourselves in line with those who can. Remember, we are not the only musculo-skeletal profession trying to do this!

A parting thought – our Physio First QAP scheme is not to be feared. The analyses that has been done already as part of the first and second ever round of QAP assessment demonstrates that the vast majority of members who collect data through our Data for Impact scheme, are awarded QAP status.

Even more than that, if any member struggles to reach the baseline, our whole Physio First education strategy is there to support them as it now exists “to support our members towards and within our Physio First Quality Assured Practitioner scheme”. That is all the courses we run, our annual conference, our quarterly journal In Touch and our R & D subcommittee. No one has to fail – at the very worst, one just has to wait a little until one’s clinical outcomes reach the baseline and we are all there to support you!

Finally, we are developing a long list of FAQs about our QAP scheme that will develop to answer any question you may have, but above all to reassure all members that our Physio First QAP scheme is ours – and we intend to use it to promote the interests of our members – and that is guaranteed!

[Reviewed - September 2018]

What exactly is a Physio First QAP?

A Physio First QAP is a Physio First member who has input data using the online DfI system, who collects PROM data from their patients and whose DfI data reaches  the QAP criteria as defined by Physio First in collaboration with the University of Brighton. QAP is valid for one year, renewable annually with sufficient data collection.

[Reviewed - March 2019]

 

How do I become a Physio First Quality Assured Practitioner?

All applicants must be inputting data into our continuous web-based Data for Impact (DfI) project and must have submitted sufficient data on a minimum number of discharged patients to receive an individual report.

Our full Physio First data bank is analysed independently by the University of Brighton and it is from this data that a baseline for defining robust and defendable “quality” will be set. Any participating practitioner can be termed a Physio First Quality Assured Practitioner if they demonstrate outcomes in our individual data that are above this baseline and their patients submit data from a validated PROM which verifies these outcomes.

[Reviewed - September 2018]

Why do we need this scheme?

Society and the healthcare marketplace in 2016 demands authenticity. Validated data can be turned into evidence of this in so many ways.

As individuals in everyday life we give and share data everywhere we go – from interactive fitness apps to retail reward cards to hotel loyalty discounts.

In the healthcare marketplace, authenticity means being able to prove our cost effectiveness – our value for money. In our world as self-employed private practitioners, this is demonstrated by measurable quality treatment with outcomes. 

[Reviewed - September 2018]

How has the baseline been set?

Our Physio First Research & Development Sub Committee, together with our University of Brighton team, have agreed realistic outcome levels based upon an “equation” of outcomes that directly relate to questions in our DfI tool. It is these outcomes that together form our QAP baseline.

We have already established that we have sufficient geographical coverage of current participants to demonstrate that our national data bank is representative of our whole membership – which is both fabulous and unique.

[Reviewed - September 2018]

Which parts of our analysed data make up the Physio First QAP baseline?

The following areas of our DfI tool form the agreed Physio First QAP baseline “equation”:

  • Goal achievement
  • Outcome of referral
  • Number of treatments
  • FPS (functional, physical and subjective) score changes between initial and discharge appointments
  • Time between referral and commencement of treatment.

In addition to these, a validated PROM will need to be used by each Physio First data collector as these provide the independent patient perspective. The next step within the development of our DfI project will be to enable it to automatically collect PROMS (patient recorded outcome measures) directly from the patient and match them to the data collected by the individual clinician. This gives a further but necessary layer of independent validation.

[Reviewed - September 2018]

Will outcomes continue to be monitored after first achieving Physio First QAP status?

Yes, practitioners are required to input their DfI data on a rolling basis each year. By continually inputting data practitioners will have the opportunity to be assessed three times a year. If they have managed to input 50 discharged data sets then they will receive feedback from the UoB team and an individual clinic report. This process ensures that Physio First data collectors constantly meet the baseline as without this sort of ongoing monitoring, the credibility of our whole scheme would be undermined.

[Reviewed - March 2019]

Do I collect data on every patient?

We started slowly, asking members, with advice from our UoB team, to be random in their selection of patients about whom they input data. However, to be really robust and defendable and in consultation with our University of Brighton team, we have concluded that we have to ask members to collect data on every new patient as this removes bias.

Don’t forget the more patient data we enter the nearer to being QAP or QAC we become as we will collect the necessary amount of data more quickly. The more data we collect the more robust the analysis and the evidence of just how cost effective (value for money) private physiotherapy practice is. If we collect data on every new patient we cannot be criticised for any form of bias regarding data entry.

[Reviewed – September 2018]

Is it acceptable to collect data during a patient’s treatment?

We are also aware of the HCPC Physiotherapy Standards of proficiency - Standard 12 which can be found here

This includes the requirement for registrant physiotherapists to recognise the need to monitor, evaluate, and assure the quality of practice and recognise the value of contributing to the generation of data for quality assurance and improvement programmes.

For the collection of data to become a recognised part of patient care, there does need to be a change in culture that we feel confident can be led by Physio First members who join our Data for Impact (DfI) project and who also become Quality Assured Practitioners (QAPs). It really boils down to communication between the clinician and the patient, so that our patients can learn the value of data collection to patient care.

Collection of data during a patient’s treatment session is, in our opinion, not only acceptable but an inevitable development that is supported by the HCPC regulations. It will, however take time for this practice to become something that we all feel comfortable in deploying. 

[Reviewed - September 2018]

Why is this data different from that collected by private medical insurers (PMIs) or commercial intermediaries?

Our data is about true outcomes. A combination of factors that reflect the severity and complexity of a condition, the goals of a patient and the ability/competence of the therapist to manage that condition effectively. This is a unique equation that we believe, and other marketplace stakeholders echo, has no equal in the physio healthcare world at the moment either nationally or internationally.

Other really important factors are:

  • As Physio First, only we own all our data – no one else – which leaves us free to make collective decisions about how we share this, with whom and with what aim. We will always work with our members to champion this data
  • The baseline has been set through the collaboration of Physio First and the independent University of Brighton using our data
  • Our QAP and QAC quality kite-mark is ours to use and sanction as Physio First – again, no one else’s

[Reviewed - September 2018]

I already collect all my own clinic data, is that not enough?

Of course, we should all already collect our own data, and many do this through a practice management software system but the difference with our Physio First DfI collection project is that the data collected is through a validated standardised data collection system. Your individual or clinic data is then analysed by a third party (the UoB) against the national average in our growing data bank. This results in the UoB team being able to measure “apples with apples” independently of any individual bias. The data we collect within our own practices is not standardised nor analysed by a third party and so is not defendable in the same way.

[Reviewed - September 2018]

I would like my whole clinic to be a QAP clinic. How do I do that?

In September 2018 we have launched our Quality Assured Clinic scheme, please see our FAQ here ‘How does my practice become a Physio First Quality Assured Clinic?’ or see our QAP/QAC benefit page.

[Reviewed - September 2018]

I want to be a member of Physio First and am happy to collect data but don’t feel I want to become a QAP. Will this matter?

No of course not. There will be some of us who choose not to become a Physio First QAP because this sort of scheme does not match our own business model, type of practice, future plans or time of life. Physio First will continue to benefit all members.

[Reviewed - September 2018]

What will happen if my individualised report doesn’t meet the QAP/QAC criteria?

There will be some of us whose data might not quite meet the criteria for QAP/QAC in that although 50 data sets may be submitted within the 12 month time frame, their DfI data may not achieve the minimum of 3 out of the 5 criteria needed. The UoB will contact all  members to let them know which criteria did/or did not achieve the national standards. This will then enable individuals to target these areas for improvement through their CPD. Physio First as an organisation will never know which members do not meet the standards and these members will NEVER be identified by the UoB in any circumstance.

In addition, our education programme will be targeted towards broad areas, identified by the unstacking of our data, to where member outcomes would benefit the most from CPD.

[Reviewed - March 2019]

I am a sole practitioner – all my patients are returners or recommended by other patients and are mostly self-paying. Why would I join the scheme?

We are sure that, as private practitioners, we all want to feel confident enough to shout about our quality and ability to prove our worth through our outcomes. The public understand the words “quality assured” and to be able to market ourselves as such through our Physio First QAP and QAC kite-mark will not just feel good, but will future-proof our practices.

We have a plan to market our QAP and QAC schemes vigorously to all marketplace stakeholders to include directly to the public. The more QAPs and QACs we have, the more effectively we can do this.

[Reviewed - September 2018]

What if my practice is non-MSK focused? Can I become a QAP?

Not yet. Our 2016 Practice Profiling survey demonstrated that more than 90% of Physio First members have MSK as their main specialty. However, in the next phase of our journey, Physio First will investigate how our QAP scheme can be expanded to include other physiotherapy specialisms in private practice.

That said, our other 4 Big unique member benefits apply to all members whatever their expertise, so Physio First remains the “go to” organisation for all self-employed private physios.

[Reviewed – September 2018]

I only work part time, I would love to be QAP as I think I can achieve this, but it will take me a very long time to collect sufficient data sets. Is there anything I can do?

As we have launched our QAC scheme in September 2018 this was something else that our R&D sub committee needed to consider. We needed to reflect working hours with the number of data sets required but we were working out how we could do this and still be able to say confidently that “we have enough data to prove quality”. Now we have launched our QAC, please see our FAQs on our QAP/QAC page here.

In order to be assessed for QAP, as a sole practitioner only, you need to input 50 completed data sets within a 12-month period. If you work within a private clinic which is owned by a Physio First member and working towards QAC (Quality Assured Clinic) then you can be part of the team as your hours will be taken into account in proportion to the whole clinic. In this case you would not get individual QAP but be a member of a QAC.

[Reviewed - September 2018]

What might an organised network of Physio First QAPs be able to achieve?

As Physio First, we have had a plan in place since 2013 to work towards the creation of a business entity or business entities that are private practitioner owned and that can compete in the marketplace with private medical insurers, commercial intermediaries and even expand self-employed private practice beyond its current boundaries.

Since then our working title for this project is “The Physio Co-op”.

We have published information on what has amounted to a huge investment of time and energy in trying to establish a blueprint of what it takes to construct such an entity, with the greatest chance of succeeding.

To track the activities that have been undertaken to date and/or to keep up with our current activities and thinking please follow our regular newsletter The Core. All editions can be found in the members’ section of our website.

[Reviewed - September 2018]

If I become a Physio First QAP, do I have to be part of this separate Goal 9 entity?

Absolutely not. As with everything, this will be an individual business decision. You may wish to market your Physio First QAP status directly to your patient group. Alternatively, you may wish to join with others where you share the risk of entering the marketplace as a profit sharing supplier of physiotherapy and then of course share the rewards of success once trading.

[Reviewed – September 2018]

 

Data for Impact

Why should I join Physio First's Data for Impact?

Physio First, together with the University of Brighton and funded by the PPEF have developed the Data for Impact programme which enables our members, through submitting anonymised treatment and outcome data on their patients, to obtain national reports on the efficacy of physiotherapy. This information enables us to champion evidence based, cost-effective physiotherapy to our stake-holders and our patients. 

It is only by participating in Data for Impact that you can become a Physio First Quality Assured Practitioner (QAP) or Physio First Quality Assured Clinic (QAC)

Full details of how to get involved in our Data for Impact can be found here: Data for Impact

[Reviewed - March 2019]

What is Data for Impact (PF-DFI)

In 2005 the Standardised Data Collection System was developed for private practitioners by Physio First, with the University of Brighton (UoB), and funded by the Private Physiotherapy Educational Foundation (PPEF).

Between 2009 and 2013 Physio First members used this system to collect data which was analysed and then published in 8 snapshot reports which are now available to members by clicking here to follow through to our benefits page where they are located.

In 2013 the UoB and Physio First evolved a new, shortened version; the short form tool that is easier to complete than the previous versions, and will be permanently available to our members. So, having learned over the past 5 years “how to collect and analyse data”, we can now not only continue to do it, but also begin the process of learning how to use it.

This short form tool was piloted between March and Mid-April 2014, and our preliminary results were analysed. Following the success of this pilot, the full collection project was launched in November 2014. If you wish to have access to an example of the later shortform tool results, please contact Physio First on 01604 684960 or email us on minerva@physiofirst.org.uk


Exciting times
The short form tool was launched November 2014 as a permanent, on-line, developing bank of data that is downloaded and analysed every two months.
To see the latest National Interim report please click here:

October 2017- National Interim Report

January 2018 - National Interim Report


Physio First, and in time individual practitioners, will be able to draw upon this analysed data to fight our market place battles, “champion” private practice and back up what “we know we know”; without this data, who would listen? Please join in this collection by clicking on the link:  Join the Physio First Data for Impact (PF-DFI) Study

You can contact Liz Bryant, Shemane Murtagh or Lisa Hodgson at the University of Brighton via email physiosurvey@brighton.ac.uk or phone 01273 641802 (answerphone). We also have a five minute tutorial that will help you get started in using the online data collection tool, see here

If you want to hear what our Chairman and Vice Chairman had to say about the value of the project at our 2014 Physio First conference click below to view their presentation: “Data Collection Revealed” Conference Presentation 2014
 
If you would also like to hear how pivotal this data is to our future and why you really do need to join this collection please click on this year’s presentation from our Chairman – “Physio First Revealed” Conference Presentation 2015: “Physio First Revealed” Conference Presentation 2015

[Reviewed - June 2018]

What will our individual Data for Impact reports look like?

To see an example of the type of report that individual participants in our Data for Impact project will get, please click on the link at the bottom.

As reported in our May 2015 Update, the reaction to sample reports from colleagues who saw them for the very first time at our annual conference included:

  • “These reports will give us knowledge about ourselves that is knowledge that others don’t have and that feels powerful”
  • “A fantastic opportunity to compare against the national average in a non-threatening way”
  • “As my practice is 82% self-referral I would be looking to use these reports to inform our patients and the general public about our outcomes alongside other referrers”
  • “One of the biggest things for me would be the feeling of ownership and being a part of something very important for private physiotherapy practice”
  • “I think the individual reports will confirm lots of what I ‘thought’ about my practice but it will be very exciting to see actual data saying so”
  • “They will clearly identify areas of strengths/weakness/opportunities for both practice principals and contributing associates”
  • “A big plus is the dynamics that these reports will present for the Physio and our patient – a sense of ownership for the patient that they are part of the project even though they are anonymised which I think will make them feel they are playing their part and ‘feel good’!”
  • “The individual reports will give us a peak through the window into how good we are and how we help our patients”
  • “It just shows what an amazing profession we are part of”
  • “Immediate audit of where patients “come from” and how the majority pay”


Please remember:

  • You can join in our Data for Impact Project at any time
  • Practiced members say that they can complete the data required at the rate of 3 minutes per patient
  • This is a unique Physio First member benefit that is not available anywhere else in the world
  • The minimum number of discharged datasets required to make an individual report tenable is 50 within a 12 month period 
  • Individual reports will be available 3 times following the data downloads in January, May and September
  • Individual reports against our national Physio First database will be private to each of us
  • This project produces “evidence” and our executive’s view is that “evidence is the new marketplace currency” – do not miss out

So come on … join us … and let’s all start collecting our own evidence and disrupting our marketplace together

To see the latest report please click below:

Sample report

To join our Data for Impact project go to Data for Impact or email our University of Brighton Team on physiosurvey@brighton.ac.uk  

[Reviewed - March 2019]

Can I use the BmPROM with children under 16?

The BmPROM has not been validated with children and therefore it is not necessarily recommended for use with this population. Variability in children's development and ability means chronological age is not a hard and fast criterion for judging whether children can self-report and complete a questionnaire. If your patient base includes children under 16 we recommend that the choice of a suitable PROM for patients under 16 years should be at the practitioner’s discretion and based on the age and comprehension of the child. It may be that the BmPROM is the best solution in some cases.

The University of Brighton team are not aware of a validated MSK-PROM that is child-specific. They have advised that there are a number of child-specific instruments available that are designed to measure health and wellbeing. These instruments tend to vary in terms of the item content, constructs and domains. There is also variation in the reliability and validity evidence supporting each of the measures.

If your client base is predominantly children and you need further guidance we suggest you contact the University of Brighton team to discuss which PROM is most appropriate for you.

You can call or email us on 01273 641802 (answer phone) or physiosurvey@brighton.ac.uk

[Reviewed - June 2018]

How were the diagnostic codes decided for the Data collection (Data for Impact) project?

In August 2005 the Private Physiotherapy Educational Foundation (PPEF) funded a two-year project to develop the standardised data collection (SDC) tool. Members of the initial steering group were; from the PPEF: Fleur Kitsell (Chair), Jean Kelly, Erica Nix, Gillian Jordan (PPEF); from the University of Brighton: Prof. Ann Moore, George Olivier PhD and Liz Bryant PhD; from Physio First (then OCPPP): Carol Owen, and Carol Baxter an independent private practitioner. Subsequently, in 2007, Eric Lewis (Physio First) also joined the steering group.


Development of the SDC content for PPEF

Focus group interviews were held in the autumn of 2005 in London and Leeds. Practitioners were provided with an existing SDC tool which had been used earlier by the NHS (v1.0) and were asked to comment on the relevance of its content and use in private practice.  

This early version contained 33 items, including a general diagnosis/aetiology field with 11 response options, and a specific diagnosis field with 48 response options. Both the London and Leeds focus groups made various suggestions to amend the layout and content of the tool. These were presented to the steering group meeting at the end of 2005, following which the SDC content was revised. Further revisions, based on feedback from 16 practitioners who undertook a one week feasibility study, and from 14 practitioners who piloted the tool for four months, resulted in various subsequent iterations of the SDC tool.  

In December 2010 v1.8 contained 42 items including a “general diagnosis of the presenting problem” field with 13 response options. There was a “cause of onset of the presenting problem” with six response options and the “specific physiotherapy diagnosis” with 51 response options. 

When the Short Form SDC was developed in 2013 a number of items were removed from the tool including general diagnosis

In the current online SDC/Data for Impact tool the specific physiotherapy diagnosis field has 58 response options.

The list of items is reviewed at regular intervals and revised to reflect the changing nature of physiotherapy practice. For instance, in 2014 neuromuscular imbalance/instability was added as it was considered that the underlying biomechanical misalignment that causes a patient’s presenting condition, is more than just related to posture, proprioception or core instability, and is, in fact a physiotherapy issue.

[Reviewed - June 2018]

How do I get started inputting data using the online Data for Impact (DfI) system?

Once you have registered for the DfI study with the University of Brighton (UoB) you will be sent a link to access the online system, your unique access code and password, as well as a User Guide and link to a brief “getting started” video tutorial to help guide you. We would recommend that you look at the video prior to inputting any patient data.

Watch the 'Getting started' tutorial here

How to access the online DfI system?

How to access the online DfI system - bit.ly/Data4Impact

Press the control key on your keyboard and click on the link to access the new DfI server. You can save or bookmark this website link to your computer to allow quick access in the future. 

Problems with your DfI login?

Please note when entering your DfI login details that these are case sensitive. If you are having problems accessing the new server with your account name and password then please contact the UoB team via email physiosurvey@brighton.ac.uk or call 01273 641802.

NB: If you have not accessed the system for some time, and you did not update your GDPR contact preferences with UoB in 2018 then you may have been withdrawn from the study. Don't worry if this is the case as you can easily re-join by registering using the online registration form https://tools.brighton.ac.uk/P1st_signup/PF_DFI_register.php

[Reviewed - March 2019] 

How do I access a Patient Recorded Outcome Measure (PROM)?

As part of the QAP and QAC practitioners are required to be collecting patient recorded outcome measure (PROM) data from their patients using a validated PROM. Currently Physio First do not specify which PROM you use and do not require to see your PROM data.

For those of you who are not yet collecting PROM data from your patients then we invite you to consider using the Brighton MSK PROM (the BmPROM). This is an eight item validated PROM that is freely available for your use (in online or paper format), which takes patients less than 5 minutes to complete. Patients complete the BmPROM before the first treatment and after the final treatment. 

If you are already participating in the DfI study then you would have been sent a link with further instructions on how to access the BmPROM online. Please contact UoB team physiosurvey@brighton.ac.uk if you would like to use the BmPROM either in paper format or online.

The BmPROM is available HERE as a .pdf doc for you to download and use the paper version within your clinic if you are not able to use the electronic version. It is also available to download from the online DfI system under the Resources tab after you have logged in. 

At the moment Physio First are not specifying which PROM to use, but it does need to be a validated PROM. There are several which are also easily available on the internet:

  • Visual Analogue Scale (VAS)
  • Roland Morris Disability Questionnaire (RMDQ)
  • Measure Yourself Medical Outcome Profile (MYMOP)
  • Patient Specific Functional Scale (PSFS)
  • Musculoskeletal Health Questionnaire (MSK-HQ)
    • The BmPROM is a 2-page questionnaire with 8 questions.
    • A scoring sheet explains how to measure these outcomes.
    • In addition, there are 4 optional supplementary questions for before and after treatment.
    • You may choose to include the supplementary questions which will give you additional information about your patient, but this information is not included in the BmPROM score.
    • The patient will need to complete the BmPROM at the beginning and the end of their course of treatment.

[Reviewed - March 2019]

How many discharged patients records do I need in order to be assessed for the QAP scheme?

A minimum of 50 completed, i.e. discharged patient, data sets need to be input on the DfI system within a 12 month period in order for your data to be assessed by the University of Brighton (UoB) for QAP status.

Please be aware that only complete data sets are counted towards the QAP scheme.

The computer will count all records which could include incomplete or blank records.

How do I know how many discharged data sets I have completed?

The number of discharged patients can be checked by logging into the DfI system. Once in the system, if you click on 'view list of discharged patients' this will take you to a page that lists your discharged patients. The total number of your discharged patients is shown at the top of the page.

Please note that the number of discharged patients displayed will include ALL patient records that you have discharged from the system since joining the DfI project (not just iwthin the last 12 months). It will also include any blank records in the list. 

[Reviewed - March 2019]

How can I speed up the process of getting the information I need for the BmPROM from my patients?

Here are some suggestions from those members who have been collecting data for some time.

  • Ask your patients to arrive 5 - 10 minutes early for their assessment appointment and advise them there will be a form to be completed. This warns them to bring their glasses if needed!
  • Get the patient to complete the BmPROM, or other PROM form, prior to entering the treatment room. Even if they cannot complete the whole form they will (hopefully) have read and thought about their response.
  • Print out FPS page from the User Guide and get your patient to look through this and decide which number they fall into. If they find this difficult they will have at least started to think about this prior to your questions.
  • Email the forms to them to complete prior to their appointment. Be prepared for these to be forgotten or not completed so they may need to arrive 5 minutes early anyway!

If you have found any other ways of improving this process that you can share, e.g. sending a text reminder, please share your suggestions on the LinkedIn forum.

How often is data downloaded by the University of Brighton?

Data is downloaded and analysed by the University of Brighton (UoB) in January, May and September each year. They will email you with a reminder when each analysis is due to happen to enable you to input your discharged patients in time.

The team at UoB, prepare individualised reports for those practitioners who have input at least 50 completed (discharged) patient data sets. These practitioners’ data will also be assessed for our Physio First QAP scheme.  Please note that only patients who have been discharged from the DfI system will be included within the data analysis. 

The UoB team will aim to give individualised feedback regarding QAP status within two months of each download (so by March following the January download; by July following the May download and by November following the September download).

How do I get an individualised report?

Following each data download (in January, May and September) the University of Brighton (UoB) team will prepare individualised reports for all practitioners who have input 50+ completed (discharged) patient data sets within the previous twelve month period. The individualised reports will be distributed via email within two months of the data download (allowing time for the data analysis and reports to be prepared). 

Individualised reports will include your clinic data for the previous 12 months alongside the national data for the previous 12 months.

[Reviewed - March 2019]

Do I have to input data for every patient?

To be really robust and defendable, we have concluded, in consultation with the University of Brighton (UoB) team, that data collection needs to apply to every MSK patient we see, including all new MSK patients to avoid biasing the results.

The more patient data you can enter the nearer you come to being a QAP, and the more data we all collect, the more robust the analysis and the evidence of just how cost effective (value for money) private physiotherapy practice is.

Collecting data on every new patient will remove the possibility of bias to our project.

I have a lot of patients I see/review on a regular basis due to their chronic condition, will this affect my chance of QAP status?

We have received several enquiries regarding recording data for ‘maintenance type’ patients, e.g. patients who come for a one-off treatment every 12 weeks. Please record these as a new patient on each occasion, and record them as being discharged on the same day.

With regard to recording information on discharge you are not then expected to report a Functional, Physical and Subjective (FPS) outcome score, however you will know whether the goals agreed with the patient prior to the session were achieved. 

For the Outcome of Referral please record this as ‘Maintenance type patient’.

What about factors influencing outcome of treatment that are outside of my control?

Within the Data for Impact (DfI) system you have the opportunity to record any factors outside of your control that you feel have the potential to influence the outcome of treatment for your patient. There are 27 factors available to choose from and you can report up to four factors per patient. If your patient has any factors that will influence the outcome of their treatment then it is important to document these within this section.  We suggest you read this list carefully.

For example, if a patient contacts you today to book an appointment for an existing condition but he/she is unable to attend your first available appointment then you should select ‘Patient unable to attend first available appointment offered’ as a possible influencing factor.

Equally, if there is a time delay between the injury and the patient seeking treatment, e.g. when a patient waits several weeks after incurring an injury prior to seeking treatment, then select ‘Time since onset’ as an influencing factor. 

To give an accurate representation of your patient situation.

  • Diarise when the patient made contact with your clinic.
  • Note the date of the first appointment offered to them.
  • Was any delay in seeing them due to their unavailability?
  • Did the patient delay in getting treatment which will influence your outcome?
  • Does your patient have other medical conditions that will affect the outcome of their treatment?
  • Does your patient have any psychological problems, e.g. anxiety, depression, that could affect the outcome of your treatment?

How do I record the cause of onset if it is unknown?

Within the Data for Impact (DfI) system you are asked to record the cause of onset of presenting symptoms. There are six options available: 

  • Spontaneous
  • Leisure activity
  • Sport
  • RTA or trauma
  • Work
  • Other

If the initial cause of onset of presenting symptoms is unknown. i.e. without apparent cause, then please record the cause as ‘spontaneous’. 

If the cause of onset of presenting symptoms is known, but different to any of those specifically mentioned then please record the cause as ‘other’.

How do I change or update treatment details?

If, after the initial treatment, you change or update the treatment modalities used then you will need to record this information on the Data for Impact (DfI) system.

Log into your data input page and find the name of the patient that you wish to change the details for in ‘view list of existing patients’. Your User Guide gives detailed instructions on how to find your patients’ details

Go to 'treatment details' -> first change

Input the additional treatment given.        

We would highly recommend you look at this brief video clip advising how to record your update in treatment modalities used https://www.youtube.com/watch?v=kNhzTi9MUT8

You can update treatment details up to 4 times.

It is useful for the data collection if you record any changes in treatment. This will enable the University of Brighton (UoB) to analyse outcomes by treatment modalities for a particular condition.

What criteria are being measured for QAP and QAC status?

The five criteria relevant to QAP and QAC are:

  1. Goal achievement
  2. Outcome of referral
  3. Number of treatments
  4. FPS (functional, physical and subjective) score changes between initial and discharge appointments
  5. Time between referral and commencement of treatment.

A minimum of three of the five criteria need to be met in order to be eligible for QAP/QAC award. The three out of five crtieria allows flexibility and ensures that all clinics have the potential to achieve this award. This would include for example specialist clinics that may experience the following:

  • a longer waiting time due to increased popularity 
  • complex caseload due to specific expertise

We would recommend that when completing the discharge information on the DfI system for each patient you record any relevant information in the 'factors limiting the outcome of treatment' section. 

As part of the QAP and QAC practitioners are required to be collecting patient recorded outcome measure (PROM) data from their patients using a validated PROM. Currently Physio First do not specify which PROM you use and do not require to see your PROM data.

For those of you who are not yet collecting PROM data from your patients then we invite you to consider using the Brighton MSK PROM (the BmPROM). This is an eight item validated PROM that is freely available for your use (in online or paper format), which takes patients less than 5 minutes to complete. Patients complete the BmPROM before the first treatment and after the final treatment. 

If you are already participating in the DfI study then you would have been sent a link with further instructions on how to access the BmPROM online. Please contact UoB team physiosurvey@brighton.ac.uk if you would like to use the BmPROM either in paper format or online. 

[Reviewed - March 2019]

What happens if the patient cancels their final appointment and I cannot give accurate discharge date, or get them to complete the PROM at discharge?

If possible try contacting the patient to obtain relevant information for completing the discharge outcomes.

If the patient will not respond then leave the Functional, Physical and Subjective (FPS) score blank when discharging. Note any ‘influencing factors’ that might have affected the patient’s outcome.

Please do not delete patients who do not attend. While you will not be able to report a goal achievement or a FPS score on discharge, you will be able to record the ‘Outcome of Referral’ and select the most appropriate option, such as ‘Treatment interrupted (failed to attend, practice informed /not informed)’ box.

The reality is that we will all have some patients that fall into this category, so we have to record the data and (lack of) outcomes. This adds to the variety of data collected. If it was found that a majority of patients fell into this category then it should be cause for questioning and a reflection issue as to what was causing this.

How does Physio First ensure that the data uploaded on Data for Impact (DfI) is reliable and unbiased?

All studies are dependent on the accuracy of the data given which, in this case is not subject to independent verification. As professionals, and within our professional codes of conduct (see further reading), we would require that accurate data is given to ensure the integrity of the study.

Patient outcomes, as collected via the DfI system (a standardised data collection system) are analysed independently by the University of Brighton (UoB) who in turn are able to advise individual participants whether they have meet the QAP or QAC criteria.

In addition, we are now able to collect Patient Reported Outcome Measures (PROMs) electronically, including the BmPROM, which will further validate the data.


Further reading

1. CSP code of conduct  (2012)

http://www.csp.org.uk/publications/code-members-professional-values-behaviour

2.2    Members act with integrity, honesty and openness

2.2.3    Provide truthful and accurate information.

3.3    Members communicate effectively

3.3.3    Provide full, accurate and truthful information about the services that they deliver, including the outcomes of their activity

4.4     Members support the development of Physiotherapy

4.4.1    Contribute to the development of physiotherapy, including by enhancing its evidence base and implementing this in practice


2. HCPC Standards of Conduct, performance and ethics (2012)

http://www.hpc-uk.org/assets/documents/10003B6EStandardsofconduct,performanceandethics.pdf

3.     You must keep high standards of personal conduct.

10.     You must keep accurate records.

13.     You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.

You must justify the trust that other people place in you by acting with honesty and integrity at all times. You must not get involved in any behaviour or activity which is likely to damage the public’s confidence in you or your profession.

[Reviewed - March 2019]

Are there any tips for inputting data to the online system?

We will all have different ways of managing this.

  • Inputting data whilst with the patient is in the treatment room. This has been found to help the patient to engage with the process.
  • Completing a paper form while the patient is in the room. The paper form can be found in the User Guide supplied by the University of Brighton (UoB).
  • Input relevant information to the online system from written patient notes when is convenient for you.

In this instance we advise inputting as soon as you can after seeing the patient.

You may find you need to adapt your systems in order to have accurate information, e.g. did the patient take the first appointment offered or was the delay in seeing the patient due to their inability to attend? If this is the case then record this under ‘influencing factors’ patient unable to attend first appointment offered.

 

How do I report my patient's functional, physical and subjective (FPS) score?

Within the data collection software you are asked to report the FPS score for your patient at the initial appointment and subsequently on discharge. We are aware that there is a lot of information within the scale and it is not always practical to go through the scale with your patient on your computer/tablet. We would, therefore recommend that you print a copy of the scale to hand to your patients for consideration (perhaps a laminated copy so this can be reused). The scale is listed in the User Guide or alternatively you can download a copy here

You might find that your patients do not neatly fit a single item/description on the scale, but we would ask that you focus on the most important factor for each patient at their initial visit, e.g. if sleep deprivation, i.e. disturbed sleep every night, is the biggest concern for them then they should select the most appropriate response based on this. So, in this instance they would select 9 on the FPS scale (even if they don’t have all the other symptoms within the description). Subsequently, on discharge you would ask them to rate where they are on the scale based on the same factor, i.e. how they are sleeping.

What impact will collecting this data have on my practice?

At the beginning of 2016 the University of Brighton Data for Impact (DfI) team sent out an online survey asking questions regarding the experience of, and impact on participating practitioners. The survey, comprising of five open ended questions, allowed us to perform a qualitative analysis which provided a valuable insight into the impact of the data collection. We had a good response from this survey, and four themes emerged from the data. These related to:

  • The individual practitioner. This is multifaceted and included:
    • personal and practice development such as stimulating reflective practice, awareness of the importance of data and improvements in day to day practice
    • professional development such as identifying CPD needs and facilitating treatment evaluation and
    • supporting the profession through commitment to contributing to the knowledge base.
  • The business theme comprising two categories:
    • new knowledge, i.e. increased awareness of patient profiles and the importance of benchmarking and
    • use of data in informing practice, i.e. for business management, marketing, education and practitioner development.
  • The patient focus related to the patient's perceptions and including quality assurance and time scale issues.
  • The practicalities of data collection. The key issue was the increased workload, time limitations, time taken to input data, and software compatibility.

Overall, the feedback varied. Some comments were entirely positive in terms of the impact DfI had had on personal, practice and professional development and on the participant’s business, while others had more mixed feelings. The negative impact reported was the increased workload, specifically the extra time commitment the data collection entailed. Importantly however, whilst there is an issue concerning the time required to collect this data, the benefit of participants being able to show how efficient, timely and equitable their services are will provide valuable support to them in the ever changing healthcare market.

The findings from this survey have been very useful for Physio First members, and the physiotherapy profession. It has been written up as an abstract, and was presented at the European Congress of the European Region of the World Confederation for Physical Therapy (ER-WCPT) which was held in November 2016. 


Feedback on the individualised reports

In December 2015, we sent out individualised reports for all practitioners who had input more than 40 discharged patient data. These reports provided practitioners with an overview of the data from their practice reported alongside the national data, click here for an example.

The individualised reports were prepared and distributed via email to practitioners. Once the individualised reports were issues, we sent an email with a link to an online survey questionnaire asking for any feedback. 

The responses to this survey were very positive. The majority of practitioners found the report useful for their practice and reported that it was easy to read and interpret. Almost all stated that it was useful to see their data alongside the national data and found this process beneficial in understanding the profile of their practice and to make comparisons against the national data.

Practitioners found the referral information and the outcome information particular useful. Overall, practitioners stated that the report has been very useful and that they had been able to use the data for a number of purposes including marketing, CPD and auditing.  

Please note that now practitioners need to input a minimum of 50 discharged patient sets in order to receive individual reports.

Is it acceptable to collect data during a patient’s treatment?

We are also aware of the HCPC Physiotherapy Standards of proficiency - Standard 12 which can be found here

This includes the requirement for registrant physiotherapists to recognise the need to monitor, evaluate, and assure the quality of practice and recognise the value of contributing to the generation of data for quality assurance and improvement programmes.

For the collection of data to become a recognised part of patient care, there does need to be a change in culture that we feel confident can be led by Physio First members who join our Data for Impact (DfI) project and who also become Quality Assured Practitioners (QAPs). It really boils down to communication between the clinician and the patient, so that our patients can learn the value of data collection to patient care.

Collection of data during a patient’s treatment session is, in our opinion, not only acceptable but an inevitable development that is supported by the HCPC regulations. It will, however take time for this practice to become something that we all feel comfortable in deploying. 

[Reviewed - September 2018]

How do I access help with inputting data if I cannot find the answer here?

If you have any questions regarding how to input your DfI data then please contact the UoB team by email physiosurvey@brighton.ac.uk or phone 01273 641802 (answerphone).

Useful links    

Access to the online system        bit.ly/Data4Impact

You can save or bookmark this website link to your computer to allow quick access in the future.

Access to the video tutorial       https://www.youtube.com/watch?v=W34_3sp3R40&feature=youtu.be

[Reviewed - March 2019]

Having problems with seeing all the DfI page?

If you are experiencing difficulties seeing the bottom of the DfI page please can you use the "zoom out" function in the browser screen resolution. Please see the images and instructions below on how to do this for the different web browsers.

If you are accessing the system via Internet Explorer then you will need to click on the wheel in the top right corner and then click on the zoom our button (see image below) 

 

If you are accessing the system via Google Chrome the screen will look slightly differently (shown below). Here you click on the "3 dots" at the top right of your screen, then click on the Zoom minute button. 

 

And if you are accessing the system via Mozilla Firefox the screen will look as shown below. Here you click on the "3 lines" at the top right of your screen, then click on the Zoom minus button.

Any queries then please contact the UoB team physiosurvey@brighton.ac.uk or call 01273 641802 (answerphone).

[Reviewed - March 2019]

What data is analysed by UoB for the QAP/QAC scheme?

Remember that only data that is discharged will be included in the analysis by UoB.

Please be aware that only complete data sets are counted towards the QAP scheme. The computer will count all records which could include incomplete or blank records.

You will need at least 50 discharged patients within a 12 month period.

[Reviewed - March 2019]

 

GDPR

What are the rules for supplying patient records to patients or solicitors?

Under the General Data Protection Regulation 2018 (GDPR), if you receive a request in writing from a patient for a copy of their medical records to be sent to them (or more commonly to their solicitor or a nominated intermediary) you must supply a copy of their medical records within 30 days.

Please always check that there is a written request that is signed by the patient himself or herself.

In most cases you cannot charge a fee to comply with a subject access request whether it is directly from the patient or from their solicitor on their behalf.

However, as noted above, where the request is manifestly unfounded or excessive you may charge a “reasonable fee” for the administrative costs of complying with the request. But such circumstances are likely to be rare and require a full explanation if relied upon.

You can also charge a reasonable fee if an individual requests further copies of their data following a request. You must base the fee on the administrative costs of providing further copies.

To conclude therefore, with the General Data Protection Regulation 2018 a charge must not be made for subject access requests.

On these points, we fully understand that a lot of members (as well as a great number of other healthcare practitioners) are very frustrated at not being allowed to charge for the time and effort that it takes, especially as it was permissible to charge up to £50 under the old Data Protection legislation. As a result, we get regular contact from members looking for opportunities to charge. Whilst we completely understand the sentiment, our very strong advice is to view it all pragmatically i.e. with a “business head on”, because even if you find yourself with a reasonable case to charge (e.g. you regard the request as “manifestly unfounded or excessive”) the time and energy involved in arguing that position is most likely to outweigh any benefit of any administrative charge.

Finally, the most authoritative source we can find for guidance on this issue is that of the BMA dated 06 December 2018 and entitled General data protection regulation (GDPR) - for which here is the link https://www.bma.org.uk/advice/employment/ethics/confidentiality-and-health-records/general-data-protection-regulation-gdpr

[Reviewed - December 2018]

What has Physio First done about GDPR compliance?

As Physio First we have had to go through exactly the same processes as everyone else.

In a nutshell, we have had to complete an audit to determine the legal basis upon which we process personal data and then produced our privacy statement.

For a copy of our Audit – see here

For a copy of our Privacy Statement – see here

[Reviewed - December 2018]

What help can Physio First provide about GDPR compliance?

As Physio First we have had to learn about the new GDPR rules along with everyone else.

In doing so, we were acutely aware of the danger of directing members to so-called experts who simply re-hash what is available at no cost from the Information Commission’s Office website, as well as the danger of directing members to services that prove inadequate.

From December 2017, we had planned and worked with our transformational partner Blue Zinc, who ran nationwide evening workshops on how to become GDPR compliant and which proved very popular and very helpful.

From April 2018, and based upon really helpful and favourable feedback from our members on our private trusted LinkedIn forum we came to an agreement with our strategic commercial partner Painless Practice, to enable members to have access to a package, that includes templates, that they had developed with Technology Tamed.

So for access to the:

-       Blue Zinc webinar – cost £20 – see here

-       Painless practice GDPR package to include templates – cost £150 – see here

[Reviewed - December 2018]

Does Physio First have templates for GDPR compliance?

Yes!

Having learned about what it takes to be GDPR compliant and having listened to members, as Physio First we have come to an agreement with our strategic commercial partner Painless Practice for member access to templates developed by them and Technology Tamed for the same rate as a Painless Practice customer.

The list price is £295, but as part of our agreement Physio First members can have access to these templates and supporting material for the Painless Practice customer rate £150.

Details of the package and how to order it can be found here

In feedback from members on our private trusted member only LinkedIn Forum, members have articulated their various approaches to GDPR compliance. From using the free information on the Information Commissioners Office (ICO) website with others using combinations of Blue Zincs webinars and the Painless Practice package – see here – with still others using local external services.

[Reviewed - December 2018]

 

Practice Information

For how long should a physiotherapist retain their records of patient consultations and treatments?

Records must be retained in accordance with existing policies and current legislation.

a) Records must be retained for a minimum of 8 years after the conclusion of treatment.

b) Obstetric records must be held for 25 years.

c) Records relating to children and young people must be kept until the patients 25th birthday, or 8 years after the last entry if longer.

d) Patient records must be stored securely at all times.

e) Computerised physiotherapy records must be registered under the Data Protection Act 1984.

f) Records can only be released with the patients permission.

g) A patient or carer must be made aware that the patients records may be accessed in accordance with health authority policy.

h) A procedure must be in place for patients to access their post November 1991 records.

[Reviewed - December 2018]

Is there a set hourly rate for seeing patients on a private basis?

Each private physiotherapist sets their own scale of charges. We are unable to supply information regarding charging rates due to the Competition Act except in certain circumstances and then only to Members of the Organisation. The best way to find out the charges is to contact local practitioners. These can be found through the Find a Physio service on this website.

[Reviewed - December 2018]

Why doesn’t Physio First campaign for higher fees?

A question that Physio First has been wrestling with for years and which our strategy takes into account.

It is firstly a question of “who is Physio First?” i.e. essentially, we are a membership trade association that is run by volunteers who step up from among us and who give up their time and energy for us.

Each volunteer runs his or her own practice but also contributes masses of their own time and energy to doing the best they can for our colleague members, supported of course by our General Secretary and our office team.

In terms of meetings that we have with Bupa, AXA PPP or Nuffield or indeed any private medical insurer or commercial intermediary, these are really quite tricky in that in communicating with them we have to balance informing them of the problems that we as private practitioners face with the reality of their and our marketplace.

Reporting a problem to a private medical insurer or commercial intermediary such as:

“Our members do not like the rates that you are offering”

we know will lead to the response:

“So what are you suggesting – that we offer your members more than our position in the marketplace requires us to do? You should know that if we were to offer more:

  • We want a marketplace benefit from Physio First members in return
  • A benefit that will save us money or make us money or really help us to improve our brand
  • Unless we get that we would become uncompetitive ourselves!”

So to avoid being regarded as amateurs in a professional business “marketplace”, Physio First representatives can allude to our member dissatisfaction but cannot yet address an insurer’s legitimate question as to what Physio First members can do for them in terms of helping insurers to make money, save money or improve their brand – but we have a plan!

If we are too hostile i.e. telling insurers how we as private practitioners really detest the way that they do business and that private practitioners would be encouraged to criticise them openly e.g. by implication to their customers (i.e. our patients):

  • At best they will simply refuse to meet us any more
  • At worst remind us that if we were to encourage criticism of them then they would be “asking their lawyers to intervene!”

So again, not really a productive option as without these meetings and an open communication channel with insurers, we would get no advanced marketplace information that we can publish that helps us all.

So overall, the very best that we can hope to obtain from meeting insurers and commercial intermediaries (which we do) is to try to persuade them to tell us about what they are intending to do in the future so that we can give everyone a “heads-up” on what to expect and thus enable us as members to factor any marketplace changes that we learn about into our own individual plans.

When meeting Bupa, AXA PPP, Nuffield, Simply Health or indeed any of them, our Physio First representatives really try to walk the fine line of raising legitimate complaints, in seeking information from them and (occasionally) seeing what we can do “with them” that would benefit us as members or ward off a threat (e.g. the Physio First DBS enhanced checks that as Physio First we set up to satisfy Bupa’s demand that all private practitioners prove they are not a danger to children or vulnerable adults).

So why not just advise us all to simply band together and say “no”?

Essentially in order to “offer a united front”, Physio First as an organisation of like-minded members (like-minded in that we are passionate about what we do and we are self-employed and in business) we have to become really organised. 

To try to present a united front as groups of individual members or as individual businesses e.g. for Physio First to suggest that all members tell Aviva, Bupa, Nuffield or AXA PPP or anyone, that “we will not treat their patients for less than £x per session”, would be to put ourselves in breach of the law and also very likely to shoot ourselves in the foot.

The legal danger is that we would leave ourselves open to being sued by the private medical insurers or commercial intermediaries for trying to adversely affect competition – a subject that we have taken legal advice upon and written tomes about.

The likely outcome of shooting ourselves in the foot comes from the fact that not everyone would agree to unite.

In a free competitive marketplace some of us would regard any attempt by a group of members to band together (to effectively go on strike) to try to protect or improve fees as a major marketplace opportunity to nip in and take the business. Of course we would expect such action to be much more common among non-Physio First member businesses but we were informed of instances of members doing precisely this during the Bupa Blind Tender process in 2009.

All this tells us is that to expect such unity (even if it were legal) in a society that is set up to value competition would be naïve and it would damage to our marketplace credibility.

Bupa, AXA PPP, Aviva, Nuffield or any company we approach, where we allow ourselves to say that “our members do not like your fees” would, even if they did not say it to our face, regard us as amateurs and irrelevant and most likely simply ignore us – and rightly so. If we were them, we would think the same!

Where our Physio First strategy takes us, is on a continued journey towards marketplace credibility i.e. an expressed understanding that “if” as Physio First we are going to help our members to have an impact on the marketplace, we are going to have to create something that marketplace stakeholders value!

Some of us will remember Physio First initiatives such as:

  • Physio First Clinic Accreditation Scheme i.e. to provide an accreditation scheme for our members
  • The Physio First “RehabFirst Scheme” i.e. to become a commercial intermediary service on behalf of our members
  • Change of name from OCPPP to Physio First i.e. to create a name that has the potential to mean something to the public
  • The development of a whole suite of Physio First business courses i.e. to help members develop business skills to meet the changing healthcare marketplace
  • Physio First FAQs on business questions i.e. to answer questions that members ask that can be reviewed quickly and easily.

All of these initiatives have helped to improve our business knowledge and skills and culminated in our executive’s 2013 decision to focus Physio First’s role on championing evidence based cost effective private physiotherapy with Physio First members in the changing healthcare marketplace.

A focus that has helped us produce our Quality Assured Practitioner and Clinic Scheme – see here - both of which are designed to give our members a voice with which to talk to our marketplace about quality in a way that it has never been spoken to before. To express our value, in a way that we could never do before.

Add to this our Physio Co-op project – see here – and, as Physio First members, we have a whole new set of tools with which to impact on our marketplace. Something that we simply could not have achieved in any other way, and certainly not by campaigning for higher fees.   

[Reviewed - November 2018]

 

Safety

Can pacemakers be affected by machinery used by physiotherapists?

Some machines used by physiotherapists as part of their treatment modalities can affect pacemakers.

Each machine varies with regards to the distance considered to be within a harmful range of pacemakers and so we advise that you contact the manufacturers of any machine you are concerned about for accurate information.

The patient also should have advice from the hospital where their pacemaker was fitted, and this should be obtained and heeded. Generally, however advice relates to how a patient with a pacemaker, and in direct use of such a machine might be affected and not how machinery may affect people in the environment of your clinic as, normally, you would need to be very close to a machine for it to have any effect on a pacemaker.

Machines that may have a potentially harmful effect on the general public, such as those emitting radiation, should be shielded appropriately.

[Reviewed - December 2018]

 

Physio First

How much does it cost to join Physio First?

Full Membership:

If you join Physio First as a Full member, the initial cost is £286.

This is made up of:

  • £46 for March - March 2019/19 +
  • £240 for 2019/20 Subscription

Affiliated Membership:

If you fulfil the requirements of an Affiliate member, the initial cost is £263.

This is made up of:

  • £42 for March - March 2019/19 +
  • £221 for 2019/20 Subscription

Please note that Affiliate membership is open to physiotherapists who are employed in a private practice, the practice principal or physiotherapist manager of which is a full Physio First member.

Part-time subscribers

Part-time subscription is for private physiotherapists that work 20 hours or less and work for a clinic working towards Quality Assured Clinic (QAC) status by collecting data on all their new patients where possible.

To apply for this rate, your practice must confirm in writing that you meet the definition of a part-time subscriber, and you work 20 hours or less per week. You must also begin to collect patient outcome data on Data for Impact (DfI) and be collecting PROMs within one calendar month of joining Physio First. Part-time subscription is not available to practice principals, sole practitioners or those who are participating in DfI.

If you join Physio First as a part-time subscriber, the initial cost is £143

This is made up of:

  • £23 for March - March 2019/19 +
  • £120 for 2019/20 subscription

Journal Subscription:

Journal subscription costs only £40 and members receive copies of our Quarterly journal In Touch.

 

 

 

[Reviewed - June 2018]

The Physio First rebrand; How and Why?

The rebrand of Physio First required much consideration to align its new image and brand 'feel' with its intent.

Physio First is changing. But why are we changing and, more importantly, what does it mean for us as members?

In our edition of InTouch Summer 2016, Physio First’s outsourced Marketing Director; Laura Pegg answered a Q&A section about our re-brand and will help you all understand the reason to our re-brand.

Read the story of its conception *here

*InTouch Summer 2016 reference

[Reviewed - June 2018]

 

Other useful Information

AXA PPP: a brand to be trusted?

You will no doubt remember our article in our May 2016 edition of Update about AXA PPP’s apparent change to their proposed cuts to their physio panel, and the letter to them published from our General Secretary Paul Donnelly.

Since then (and at the time of writing) we have had no substantive response to this communication. We have also had no response to an invitation to their representatives to meet with our General Secretary and Chairman.

In an email to them dated 27 June 2016, Paul pointed out that:

“I do not appear to have had any response to my email to you of the 13th May and our Chairman and I would be grateful if you could reply.

In addition I have been notified that AXA PPP’s Specialist Relationship Advisor has been communicating ‘I can confirm that Mr Donnelly has been in contact with Julia and having discussions for the past six weeks’.

Both the lack of any reply and such statements are worrying because, other than our brief chat on the telephone, we have had no discussions or communications with you or indeed anyone else at AXA PPP during this very worrying time for our members.

In the circumstances could we please hear from you (or someone at AXA PPP) with a substantive response to the points in my email of the 25th March?”

As a significant stakeholder in the private physiotherapy healthcare marketplace, we are very careful to remain professional at all times. This means communicating with those that contact us, even if we are in dispute with them.

We have understood that the essence of a good brand is “trust”. So our question to AXA PPP remains as per Paul’s email to them on 25 March 2016:

“Are you able to give us an explanation to enable us to understand what decisions you have made, why you have made them, why the decisions are irreversible and why (if at all) our members should not have to move to a position of simply not trusting AXA PPP going forward?”

 

Update - July 2016 "It's all about relationships..."