Development and implementation of a hand therapy extended scope practitioner clinic to support the 18-week waiting list initiative

Abstract

Background A changing and competitive health market demands the need to review existing services and develop new ways of working in order to improve and maintain service delivery. Developing the role of the extended scope practitioner (ESP) and altering patient pathways through specialist hand units is one way that service delivery can be improved to adhere to the 18-week waiting time from a General Practitioner (GP) referral to the start of treatment. Methods One-hundred GP referrals for carpal tunnel syndrome (CTS) and first carpometacarpal osteoarthritis (CMC OA) were selected to attend an ESP clinic audit led by two specialist occupational therapists for diagnosis and implementation of a conservative treatment programme, which was confirmed by a consultant. The ESP clinic was audited against key performance indicators to evaluate ESP effectiveness and improvements in the patient pathway. Results The ESP can effectively diagnose and manage CTS and CMC OA patients without increasing the demand for surgical opinion or procedures. The ESP is also effective in diagnosing other conditions such as early-onset Dupuytren's disease, de Quervain's disease, ganglions and trigger finger. Conclusions ESP clinics have the potential to improve the patient pathway by providing earlier access to a specialist opinion for a diagnosis and management of hand conditions thereby improving service delivery.