A pilot project which helps patients suffering from back pain see an expert immediately, without need for referral by their GP, is proving incredibly popular. 

The service aims to improve patients’ experience and quality of care by ensuring they receive the most appropriate treatment from the most appropriate clinician as soon as possible.

Patients with lower back pain have been given the opportunity to refer themselves to a clinic run by an advanced clinical practitioner (ACP) with spinal expertise – practising out of Fairbrook Medical Centre in Borehamwood. Following a comprehensive assessment which may include further investigations, a diagnosis is reached and a treatment plan agreed jointly with the patient. Patients can be referred for specialist spinal physiotherapy at Barnet Hospital and have access to a spinal rehabilitation group. The ACPs can access spinal orthopaedic consultants for surgical opinions and are able to book patients in for orthopaedic surgery directly from the GP clinic.  This significantly shortens the time the patient has to wait for the right treatment.

Since the project began last August, 320 new patients have been seen and all those who completed a patient experience questionnaire said they would be ‘likely or extremely likely’ to recommend the service to friends and family.  Only three per cent of patients have needed to be referred to secondary care and only 11 per cent have needed further investigation with an x-ray or MRI scan. These figures are lower than for the same period in the previous year and almost four out of five patients needed just a single appointment.

If the pilot, due to come to an end this August is found to be successful and further funding provided it could be expanded to other GP practices.  The project team is led by Nicola Akehurst, an advanced clinical practitioner (ACP) and ACP clinical lead, at Barnet Hospital.

She said: “We are already seeing excellent results from the pilot with high satisfaction ratings from both patients and practice staff. The patient self-referral project was an idea that has developed over many years from our experience of treating patients with back pain. 

“When we spoke to GPs at Fairbrook Medical Centre they estimated that about 1 in 16 of their consultations were for back pain and felt that patients would benefit from seeing an ACP as their first point of call. It is very rewarding that we are now able to effectively and efficiently influence the early management of patients with back pain from this practice.”

The project was awarded £75,000 funding from the Health Foundation, as part of the charity's 'Innovating for Improvement' programme.


Image: The advanced clinical practitioner team L-R Sian Bamford, Emma Brooks, Dee Austin, Nicola Akehurst

Notes to editors

About the Royal Free London NHS Foundation Trust
The Royal Free began as a pioneering organisation and continues to play a leading role in the care of patients. Our mission is to provide world class expertise and local care. In the 21st century, the Royal Free London continues to lead improvements in healthcare. 

The Royal Free London attracts patients from across the country and beyond to its specialist services in liver, kidney and bone marrow transplantation, haemophilia, renal, HIV, infectious diseases, plastic surgery, immunology, vascular surgery, cardiology, amyloidosis and scleroderma and we are a member of the academic health science partnership UCL Partners.

In July 2014 Barnet Hospital and Chase Farm Hospital became part of the Royal Free London.