Case study: How pump priming can be used to support an Integrated Rapid Response Service

When people with Parkinson’s are admitted to hospital, they could go to any number of wards or units where they do not necessarily have access to specialist support for their Parkinson’s. The team at Derby responded to this issue initially by setting up the Integrated Rapid Response Service, where for half a day each week, a specialist occupational therapist and physiotherapist visited different wards to help both patients with Parkinson’s and the therapists providing their care.

After the pandemic, the demand on therapist services grew substantially as many people with Parkinson’s had not accessed therapy for a long time, capacity was tighter than ever. When the Parkinson’s UK Excellence Network announced the allied health professional (AHP) pump priming in 2023, this team jumped straight in!

You can find out more about Parkinson's UK Excellence Network pump priming here.

The role of a therapist within Parkinson’s

Therapists can make a big difference when supporting a person with Parkinson’s, from education and advice to an intervention that can change someone’s day to day life, increasing their quality of life.

Fiona said: “I’ve met people with Parkinson’s who have stopped going out because they just don’t know when they will freeze. By teaching them to use music as a cue, they’ve been on walks in the woods or the countryside, looking at the birds (instead of the ground) or off to the shops. These are things they haven’t done for years. Therapists can give people the tools they need to get back out there into the community or have the confidence to socialise again.

“The most important thing about Parkinson’s is self management, a therapist can give someone the tools to manage their condition and symptoms themselves. This can be empowering after what is a devastating diagnosis. They can get back to life, get back to exercising or even start exercising to help grow their confidence.”

Parkinson’s Rapid Advice and Intervention Service (PRAIS)

Fiona Lindop MBE, Specialist Physiotherapist and Clare Johnson, Specialist Occupational Therapist at Derby have been providing Parkinson’s services for a number of years. Fiona, with 46 years as a physiotherapist, used her extensive knowledge and experience working in elderly care and specifically with Parkinson’s. They held a focus group with people affected by Parkinson’s on how the Derby team could improve their service.

Pulling a bid together for a 0.6 (equating to 3 days a week) physiotherapist and 0.6 occupational therapist took a long time. After gathering all the data, they received the support of the University Hospitals of Derby & Burton NHS Foundation Trust for the initial business plan and submitted an application for pump priming funding from the Parkinson’s UK Excellence Network. A minor miracle saw all their hard work come to fruition, but that was only step one.

Recruitment came next. Beth Denny, Physiotherapist and Sophie Voyce, Occupational Therapist joined the team and immediately set up the service from scratch. During their short time in post, they’ve set out operational standards and built links with the community teams as they are not only visiting people with Parkinson’s on inpatient wards, they are also seeing people in the community to try and avoid admissions.

How it works as part of a multidisciplinary care team

The multidisciplinary care team (MDT) is made up of the physiotherapist, occupational therapist, dietitian, speech and language therapist and the staff nurses and therapy assistants with an interest in Parkinson’s. They are all based at the Florence Nightingale Community Hospital, while the consultants and Parkinson’s nurses are based at the other site, Royal Derby Hospital. Every Friday, they all come together for a Parkinson’s clinic at the Florence Nightingale site.

Sophie and Beth both start their day at the Florence Nightingale Community Hospital where they check in with the other members of the MDT team before they head off to other hospitals such as the Royal Derby or out on their community visits, all the while keeping in touch with the MDT. A lot of time is spent communicating about individual patients across different teams to deal with an existing or pending crisis. A lot of the set up of this service has been about building relationships to ease referrals so things can be done at speed.

They are there for Parkinson’s patients who are in urgent need of rapid support, advice and intervention, as the name PRAIS suggests!

Sophie reports, "Between December and  May 2024 we have been able to potentially prevent 10 admissions, supported with 55 admissions including supporting discharge, made 88 phone calls to give advice and check post discharge and completed onward referrals, signposting or home visits. We feel this work is really worthwhile and are keen to continue to advocate for the best care for the patients and family members. We have delivered training to 8 teams (sometimes split into multiple sessions to try and capture everyone when there are large teams) and have some more to complete. Over time we hope to see a ripple effect from our training and joint sessions that will mean therapists feel confident to use the strategies or techniques themselves thus increasing the Parkinson's specific input patients get.

We wish to continue delivering periodic up to date training sessions both to therapists but also the wider ward teams as we progress. Overall we hope to see the length of stay and admission rates decrease and overall better outcomes for the patient.”

Progress so far

Some patients with Parkinson’s have been admitted to hospital multiple times, with this service, they’ve visited the patients on the ward to work out why this pattern is repeating itself, asking themselves, what can we do? Quite often patients are declared ‘not medically fit’ as they are on antibiotics or have a chest infection and due to demand, the ward therapy staff might not see them until they are declared medically fit. This might mean they are lying in bed, not moving for days when movement is essential where safe. Having this service in place avoids that completely.

This service can also ensure that medication is given on time and they’ve visited people at home to avert a crisis before it happens. The team liaises with the patient’s doctor or Parkinson’s nurse to ask if medication can be reviewed or if they haven’t received their medication. The team also do follow up phone calls with people who have been recently discharged home from hospital to ensure they are managing safely and well.

Ward staff and community teams are learning more about Parkinson’s from the service, knowing what to do with future patients.

Initial data for the first 6 months of this year has shown that, compared to data from before PRAIS was set up, there has been a significant reduction in Parkinson’s admissions, a reduced number of re-admissions and more people being discharged to their own homes rather than a care facility. Healthcare professionals who have received support in terms of advice, training or joint therapy sessions have reported having a better understanding of Parkinson’s and the fluctuating symptoms, feeling more confident in offering intervention to patients with Parkinson’s and knowing where to go for help.

Learning points for others

Fiona explains, “Setting up a service like this from scratch is a huge job, the key learning has been to start with a small geographical area and then reach out further once established.”

Visiting a ward and going out into the community is a vast workload. The team concentrated on the wards first, raised their profile and set up a robust liaison process. They linked up with Accident and Emergency and the Medical Assessment Unit, as that’s often where the patient will be first admitted.

One of the biggest challenges has been the community side, with community teams, understanding what the service is and what it isn’t, setting clear expectations of what is within the remit. Building those links and relationships has been time well spent.

Next steps

“Our future aims are to establish the service and get commitment from the Trust to fund it beyond the 2 year period provided through Parkinson’s UK’s pump priming,” Fiona adds, “We’ve just appointed a psychology assistant to the team to help with counselling for people with Parkinson’s, for example when they are newly diagnosed.”

The team is also due for re-evaluation from the Parkinson’s Foundation Centre of Excellence which they’re busy gathering evidence for, and Fiona sets out the value of this, "It’s important to spend the time to demonstrate the positive impact of the service, to make sure we are there for each individual patient now and in the future".