Phio Access & Phio Engage – digital MSK pathway across the Black Country ICS

Summary

Phio Access and Phio Engage are two digital tools that when used together form a fully digital pathway for musculoskeletal (MSK) physiotherapy services and can be used in both Primary and Secondary care.

Phio Access is an MSK digital triage tool which from the patient perspective takes the form of a text chat that also incorporates interactive images and instructive videos to inform decision-making. Phio Access uses artificial intelligence that can adapt to over 3,000 decision-based scenarios and in which outcomes can be tailored to align to local service pathways. Through service referral or self-referral the patients’ MSK condition is triaged and the technology decides on the best treatment option which is verified by a clinical professional.

If self-management is an appropriate option, the patient will be referred to Phio Engage which is a digital self-management tool with tailored recovery programmes specific to patient MSK conditions and patient self-assigned goals. Recovery programmes are adjusted according to tracking outcomes such as pain scores and ability to perform exercises with outcomes regularly monitored to inform clinician intervention if necessary. Phio Engage additionally includes a chat function with a physiotherapist.

Unmet health and care need addressed

The need for digital transformation of MSK services in the Black Country Integrated Care System (ICS) was driven by several factors.

Most pertinent among these were the local clinical drivers, which are prevalent across many MSK Services nationally, and included:

Demand for MSK care being higher than capacity post-pandemic, causing waiting times to increase
Increasing clinical risk associated with increased waiting times for treatment, without thorough medical screening
Insufficient pathway with a limited workforce and Advanced Physiotherapy Practitioners spending hours triaging patients, rather than treating them.

System-level priorities and policies additionally supported the use of the platforms highlighted in this case study including:

Use of digital tools to enable patient triage and self-management of Black Country MSK Services being promoted, with a view to including the use of digital technologies in the service specification should they facilitate service improvement.

Whilst implementation of the solutions in this case study preceded the recent publication of the Independent Investigation of the National Health Service in England by Lord Darzi, and the subsequent 3 shifts highlighted in the national conversation to help develop the NHS 10 Year Plan, some of the challenges articulated in this report were previously evident to MSK services with efforts to address them having commenced. In this instance they included:

Moving care from hospitals to communities
Diverting investment into the community to improve services
Supporting patient management in the community
Facilitating patient access to community services
Making better use of technology
Using technology to support the workforce and unlock productivity
Building up the technology base of care in the community
Utilising AI to transform care
Using data collected by technology to understand community service performance

Understanding their challenges, the MSK service team at Sandwell and West Birmingham Hospitals NHS Trust (SWBH) sought a digital solution and after reviewing options chose Phio Access and Phio Engage as the solutions which best addressed their needs.

Phio Access and Phio Engage have now been in place at SWBH MSK service for two years – previously funded through the Elective Recovery Fund (ERF) and Health Technology Adoption and Acceleration Fund (HTAAF), where the latter also led to introduction of the technologies to Walsall Healthcare NHS Trust (WHT) MSK service in April 2024 and Your Health Partnership (YHP) – a Primary Care Network (PCN), which forms part of SWBH.

Phio Access is additionally used by ConnectHealth who provide MSK services across Wolverhampton, so there is already widespread use of this platform across the Black Country

However, securing recurrent funding to sustain use of Phio Access and Phio Engage where they are already used and to newly implement the platforms where they are not yet used is proving challenging at the time of writing (December 2024), despite the positive impacts of using the platforms as described below.

Operational planning guidance relevance

The implementation of Phio Access and Phio Engage aligns closely with the NHS 2024/25 priorities and operational planning guidance, which emphasizes recovery, continuous improvement in access, quality, and productivity, and the transformation of care delivery.

Improving Access and Addressing Health Inequalities:

Self-referral in addition to traditional referral routes into Phio Access to triage MSK conditions efficiently, helps reduce waiting times and ensures timely treatment, which aligns with the guidance’s focus on improving access to care.
The monitoring of demographic, socioeconomic and comorbidity information was conducted by SWBH throughout their evaluation. This enabled understanding of any potential impacts of introducing Phio Access and Phio Engage based on age, gender, ethnicity, activity levels, Indices of Multiple Deprivation, and comorbidities experienced to ensure actions could be taken to address any inequalities in service access if necessary.

Enhancing Quality and Productivity:

The use of AI in Phio Access for triage and Phio Engage for self-management enhances the quality of care by providing accurate, timely, and personalised treatment options, all of which are overseen by a clinician. Furthermore, the SWBH evaluation compared local clinician agreement with the triage outcomes of Phio Access to ensure the use of technology provided the same quality triage.
The reduction in waiting times in SWBH’s Community MSK Service from 11.5 weeks to 3.7 weeks demonstrates significant improvement in service productivity and reduces patient safety risks associated with long waiting times.
GP appointments for MSK conditions are avoided by patients using Phio Access given they are diverted to the appropriate provider in the first instance and are avoided for patients self-managing with Phio Engage, thus releasing GP time – approximately 30% of consultations are MSK related according to NHSE.
High patient satisfaction scores and the release of clinical hours for face-to-face treatment indicate improved productivity and positive opinions as to the quality of care patients felt they received.

Digital Transformation:

The integration of digital tools like Phio Access and Phio Engage supports the guidance’s emphasis on digital transformation in healthcare and aligns to ‘A digital plan for health and social care services’.

Environmental Impact:

As a digital pathway Phio Access and Engage provide modern and more sustainable infrastructure with an average saving of 13.2kgCO2e per patient in reduced travel to appointment’s, whichaligns with the NHS’s sustainability goals and commitment to Net Zero.

Network support

Throughout 2024 and as part of the first phase of this work, Health Innovation West Midlands (HIWM) have been working with the four Acute MSK service providers across the Black Country ICS, the Black Country ICB and the supplier (EQL) to:

Collate evidence to demonstrate the success of Phio Access and Phio Engage as a digital MSK pathway,
Understand the costs and contracting options available for system wide use, and
Broker the case for recurrent funding and for the sustainable spread and adoption of Phio Access and Phio Engage across the Black Country ICS in both primary and secondary care services.

Subject to the outcome of the above activities, HIWM might also have a future role in:

Supporting wider implementation of Phio Access and Phio Engage in additional MSK services and across Primary Care in the Black Country.
Development of more detailed understanding of the local net zero benefits of the platform derived from local real-world data

Impact of innovation

Evidence collated for use of Phio Access and Phio Engage, and impacts corresponding to these outcomes, included:

Demographics

A dataset of over 11,000 patients having utilised the Phio Access triage across the Black Country ICS (from January 2023 – October 2024) demonstrate widespread use of the platform representative of local population demographics.

Gender: 62.4% female and 37.6% male corresponding to greater national incidence of MSK conditions in women

Ethnicity: Patients from White, Black, Asian, Mixed and other ethnic minorities all used the Phio Access triage. The majority of patients registered as White ethnicity however, Black, Asian and Minority Ethnic (BAME) representation is above the Office for National Statistics reported population statistics for the Black Country.

Age range: Patients from all age groups from 15-85+ years of age used the Phio Access triage tool, with the majority aged 35-64 years.

Employment status: 40% of Phio Access and 53% of Phio Engage users are in full time employment. There is also representation from those working part time, students, retirees, unemployed, full-time carers, people off work due to injury or whose employment status is defined as ‘something else’.

Deprivation: Over 50% of Phio Access and Phio Engage users reside in areas ranked as either the most or second most deprived according to the Index of Multiple Deprivation (IMD). There is usage representation across 9/10 IMD rankings, however only 4.5% of users reside in the top four least deprived areas.

Comorbidities: Over 40% of Phio Access users report no comorbidities. The most commonly reported comorbidities are hypertension, breathing difficulties, diabetes and osteoarthritis.

It is important that a digital option provides equity of access for all patients and does not create health inequalities, allowing patients needing face to face care to receive it and this is what the demographic data is telling us is happening with wide scope of use across all ages, ethnicities, genders, deprivation levels and employment statuses.

Clinical service data:

The wide scope of usage has resulted in high Phio Access digital triage completion rates:

SWBH MSK service – 80% of 9,842 patients in 18 months
WHT MSK service – 76% of 1,262 patients in 8 months
YHP PCN – 86% of 330 patients in 8 months

The proportion of patients then signposted to self-management through Phio Access is:

SWBH MSK service – 9.8%
WHT MSK service – 13.5%
YHP PCN – 62%

Patients using Phio Engage to digitally self-manage their MSK condition report reduction in moderate to high starting pain scores.

Other service benefits include:

Digital pathway contributing to Net Zero saving on average 13.2kgCO2e per patient
High patient satisfaction scores with the majority rating the digital pathway as good or very good, indicated by a Net Promotor Score of 62/70 – an industry measure of patient satisfaction.

Health and care system success

In terms of service and workforce outcomes, the high usage of Phio Access and Phio Engage has resulted in:

SWBH MSK service – 1,240 hours released to face-to-face triage and treatment (12mth)
WHT MSK service – 230 hours released to face-to-face triage and treatment (6mths)

Each digitally managed patient saves on average, one triage appointment and three follow up appointments. This has contributed to significant reduction in waiting times at SWBH where in just 12 months, the mean wait time of 11.5 weeks in 2022 has reduced to 3.7 weeks in 2023. This benefits the service by meeting waiting time standards and also improves patient safety.

As well as clinical time released, there are also benefits to reduced administrative time of approximately two minutes per appointment.

The benefits of the digital MSK pathway align to the NHS 10 Year Health Plan Shifts to move care from hospitals into the community (Shift 1) and make better use of technology (Shift 2).

Economic success

According to an independent economic analysis, a Return on Investment (ROI) of ~£4 for every £1 spent is possible via saved appointments in Primary and Secondary care across the Black Country.

Scalability prospect/next steps

Through leading by convening, HIWM are working to ensure all key stakeholders across the system are aware of the local impacts of using Phio Access and Phio Engage as a digital MSK pathway tool. Through accessing this information, informed decisions can be made regarding sustaining use of the platforms in providers where they have been implemented, scaling the use of the platforms further into other MSK services and primary care, and designating recurrent funding for the above activities.

HIWM will work to support continued use of Phio Access and Phio Engage in SWBH and WHT and where requested will support implementation in additional MSK services and across Primary Care in the Black Country.

Back