Implementing a One-Off Assessment with Digital Follow Up for Rotator Cuff Related Shoulder Pain (RCRSP) in Musculoskeletal Physiotherapy.

This project was completed as part of the Coventry and Warwickshire ICB Green Team Competition. 

Team members:

David Whitfield

Andre Serra 

Sarah Brian.

Setting / patent group: 

Musculoskeletal (MSK) Physiotherapy Service at South Warwickshire NHS Foundation Trust and focused on adults with Rotator Cuff Related Shoulder Pain (RCRSP). 

Issue:

Patients with RCRSP were traditionally managed through an initial assessment followed by an average of four additional face-to-face follow-up appointments. Local data showed this resulted in around five appointments per patient episode, despite strong evidence demonstrating that similar clinical outcomes can often be achieved with significantly fewer contacts. The pathway created unnecessary patient travel, increased carbon emissions, reduced clinical capacity, contributed to waiting list pressures, and required delivery of multiple unfunded follow-up appointments.

Intervention: 

The team redesigned the pathway using evidence from the GRASP trial (Getting it Right: Addressing Shoulder Pain; Hopewell et al., 2021). Patients now receive a single extended physiotherapy appointment that includes education, self-management support and an individualised exercise programme. A bespoke digital platform provides access to exercises, progress monitoring and outcome measures over a three-month Patient Initiated Follow Up (PIFU) period. Patients can recontact the service if required, while a paper-based option ensures people without access to digital technology receive equivalent support. The pathway was initially introduced as a pilot at the Stratford-upon-Avon physiotherapy site with plans for wider rollout across SWFT.

Outcomes:

Clinical:
Modelled outcomes suggest that around 80% of patients will complete their treatment pathway without requiring any additional face-to-face appointments. Evidence from the underpinning GRASP trial indicates that a single-session approach can achieve outcomes comparable to traditional multi-session treatment. The project is expected to maintain or improve patient outcomes while increasing access to care by releasing capacity for new referrals. If implemented across the whole service, the pathway could create the equivalent of approximately 2,500 additional new patient assessment appointments annually, helping to reduce waiting times and improve access to treatment.

Environmental:
A detailed carbon footprint analysis demonstrated that redesigning the pathway could reduce annual carbon emissions from 20,915 kgCO₂e to 4,993 kgCO₂e. This represents a saving of approximately 15,922 kgCO₂e per year, equivalent to a 76% reduction in emissions. Most of the savings result from eliminating thousands of unnecessary patient journeys, by replacing repeat hospital appointments with digitally supported self-management and patient-initiated follow up. The pathway is also expected to reduce paper use and support the Trust’s Green Plan and NHS Net Zero ambitions.

Financial:
The new pathway is projected to generate staff time efficiency savings of approximately £58.75 per patient episode. This equates to around £20,000 annually at the pilot site and approximately £66,800 annually across the entire SWFT service. The reduction in follow-up appointments could release more than 1,800 clinical hours per year across the service, allowing physiotherapists to focus on new patient assessments. If the released capacity is fully utilised, the Trust estimates potential additional revenue generation of up to £150,000 per year at the pilot site and £500,000 per year trust wide through increased assessment activity. The digital platform implementation cost is minimal, with a licence cost of approximately 6 pence per patient episode. The yearly cost of printed materials will reduce from £27, to a negligible amount.

Social:
Patients are expected to benefit from fewer hospital visits, less time away from work, reduced reliance on family members and carers, and lower travel and parking costs. The project estimates a saving of approximately £29 per patient in travel and parking expenses, alongside reduced time burden and disruption to daily life. Across the full service, patient travel and parking savings are projected to exceed £32,000 annually. The pathway also supports inclusion through a paper-based alternative for patients unable to access digital technology. Potential challenges, such as digital exclusion and the need for patients to purchase their own resistance bands, were identified and mitigation measures put in place.

Key learning point 

Implementing an evidence-based, digitally supported self-management pathway can significantly improve the sustainability, efficiency and accessibility of physiotherapy services without compromising patient care. Success depends on strong clinical evidence, stakeholder engagement, equitable access for non-digital users, and routine collection of outcome data to evaluate long-term impact and support wider adoption.