Clinical Governance: An International Journal

Purpose – This paper aims to show the results from a pioneering primary care-based extended scope physiotherapist (ESP) led service, which placed patients directly onto the surgical waiting list of secondary care orthopaedic consultants over a two-year period.

Design/methodology/approach – A retrospective data review was performed on all referrals from community-based ESPs for direct listing at the secondary care hospital between 2 January 2008 and 31 December 2009.

Findings – A total of 130 referrals for direct listing were made by the ESP team during the two-year period. Of these, 127 (98 per cent) went on to undergo a THR. Three patients (2 per cent) did not ultimately have a THR.

Research limitations/implications – This process has continued over the two years of the direct listing service, with ongoing evaluation and refinement of the pathway, so referral criteria and clinical/administrative pathways have been changed in the light of experience.

Practical implications – Patients who were directly listed did not require a hospital orthopaedic outpatient appointment until attendance at preoperative assessment clinic shortly before their surgery. In addition to the reduction in inconvenience and travelling costs incurred by patients, there was an approximate saving of £145 to the primary care trust per directly listed patient.

Originality/value – The authors believe that this service evaluation is the first publication to show that direct listing by primary care based ESPs is a safe and effective process for some patients requiring primary THR.