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

Robyn-Lee Rose and Sara Probert

Guy’s & St Thomas NHS Foundation Trust, London, UK

Correspondence: Robyn-Lee Rose, Occupational Therapy Department, Ground Floor, Tower Wing, Guy’s Hospital, London SE1 9RT, UK. Email: [email protected]

Background. A changing and competitive health market demands the need toreview existing services and develop new ways of working inorder to improve and maintain service delivery. Developing therole of the extended scope practitioner (ESP) and altering patientpathways through specialist hand units is one way that servicedelivery can be improved to adhere to the 18-week waiting timefrom a General Practitioner (GP) referral to the start of treatment.

Methods. One-hundred GP referrals for carpal tunnel syndrome (CTS) andfirst carpometacarpal osteoarthritis (CMC OA) were selectedto attend an ESP clinic audit led by two specialist occupationaltherapists for diagnosis and implementation of a conservativetreatment programme, which was confirmed by a consultant. TheESP clinic was audited against key performance indicators toevaluate ESP effectiveness and improvements in the patient pathway.

Results. The ESP can effectively diagnose and manage CTS and CMC OA patientswithout increasing the demand for surgical opinion or procedures.The ESP is also effective in diagnosing other conditions suchas early-onset Dupuytren’s disease, de Quervain’s disease, ganglionsand trigger finger.

Conclusions. ESP clinics have the potential to improve the patient pathwayby providing earlier access to a specialist opinion for a diagnosisand management of hand conditions thereby improving servicedelivery.

Key Words: Extended scope practitioner • waiting time initiative • carpal tunnel syndrome