Group sessions in church halls are cutting waiting times for knees and backs.
On a Tuesday morning in the hall of St Aidan’s church in the Ardle valley, fourteen people are standing in a loose circle, rising slowly onto their toes and lowering themselves back down. Most are over sixty. Several have walking sticks propped against the stacked chairs. At the front, a physiotherapist counts aloud and reminds everyone to breathe. It does not look like a revolution, but the programme it belongs to has cut the waiting time for knee and back treatment in the valley from 19 weeks to just under five.
The scheme, run by the regional health board in partnership with church and community halls, replaces many individual outpatient appointments with group exercise classes of up to sixteen people. Patients referred with common musculoskeletal problems – osteoarthritis of the knee or hip, chronic lower back pain, recovery after joint replacement – are offered a six-week course of twice-weekly sessions near their home, rather than a hospital appointment in Calder.
How the classes work
Each patient still has a one-to-one assessment at the start, usually by video or telephone, to rule out problems that need specialist investigation. Those suitable for group work are then booked into a class. The sessions last an hour and follow a structured programme of strengthening and balance exercises that increase in difficulty week by week. Patients are given a printed sheet of exercises to repeat at home, and the physiotherapist checks progress at each session.
The evidence behind the approach is not new. Clinical trials have shown for years that supervised exercise is as effective as many other treatments for knee and back pain, and that group classes produce similar results to individual sessions. What has changed is the decision to take those classes out of the hospital and into places people already know.
“Patients were cancelling hospital appointments because the bus took two hours, or because they could not face the car park. Here they walk round the corner, they know half the room and they keep coming back.”
Those are the words of Deborah Fanshawe, the lead physiotherapist for the valley scheme, who set up the first class in a village hall in Millbeck two years ago. Attendance rates, she says, have risen from about 60 per cent for hospital appointments to more than 85 per cent for the community sessions.
The numbers behind the queue
The health board now runs 23 classes a week across nine venues, including church halls, a former miners’ institute and a room above the library in Harrow. Each physiotherapist can treat up to sixteen patients in a session that would previously have covered three or four individual appointments. Over the past year, the board estimates that the scheme has freed about 4,000 outpatient slots at the Calder general hospital, allowing physiotherapists there to concentrate on complex cases such as sports injuries and post-surgical rehabilitation.
The cost savings are modest but real: halls are rented for between £15 and £30 an hour, far below the cost of hospital space, and patients no longer require hospital transport. The board has calculated that each completed course costs about 40 per cent less than the equivalent number of individual appointments.
Patients describe the social side as just as important. Alan Kerridge, a retired joiner who had a knee replacement in the spring, said he had expected to be bored. Instead, he found himself looking forward to the sessions and has since joined a walking group formed by former class members. Several groups now continue meeting after their six weeks end, paying a small fee to keep a physiotherapist or trained instructor on hand.
Limits and lessons
The model is not suitable for everyone. Patients with severe pain, complex conditions or difficulty following instructions in a group still need one-to-one care, and some people simply prefer privacy. Physiotherapists also warn that the approach depends on a supply of willing venues and staff, and that winter weather can make church halls cold and attendance unreliable. The board has spent £60,000 on portable heaters and exercise equipment that can be moved between sites.
Next year, the scheme is due to expand to Port Selwyn and the hill towns, where waiting times remain above fifteen weeks. If the valley’s results hold, the board says it will consider applying the same model to falls prevention and to rehabilitation after heart surgery.
