Having spent over 20 years as a physiotherapist, I remember the initial problems experienced by patients and healthcare professionals in ensuring an effective joined up approach to rehabilitation.

This was especially noticeable as patients moved between stages of recovery in acute centres and then on to rehabilitation in the community.  This gave rise to the initial concept of the Rehabilitation Prescription (RP) a decade ago.

Having since retrained as a serious injury lawyer, I see similar issues still affecting my clients today.

The RP should set out exactly what treatment is required for an individual in the aftermath of a serious injury, a bespoke approach to each patient’s specific needs.

Its launch followed an NHS Clinical Advisory Group (CAG) for Trauma report in 2010 calling for better coordination of care after major trauma.

A total of 22 major trauma networks (MTNs) were set up in England and the RP was introduced.

According to the CAG for Trauma, all severely injured patients needed a RP to define their needs and explain how they should be met after discharge from acute trauma services.

Every patient admitted to a Major Trauma Centre should have their rehabilitation needs assessed and documented through a RP, it said.

The RP was created to play an integral role in improving how trauma was handled in the UK.

It should give patients and GPs, as well as rehab professionals, oversight of the identified needs and recommended treatment.

But the All-Party Parliamentary Group on Acquired Brain Injury’s (APPG on ABI) landmark Time for Changereport warned that: “RPs are not made available to all individuals with an acquired brain injury, and GPs rarely receive a copy so cannot facilitate access to neurorehabilitation services post-discharge.”

On the back of such issues, RP2019 was released last year.

This updated second version came with a stipulation that a rehabilitation assessment should take place within 48-72 hours of the patient’s admission; and that it had to be completed for all major trauma patients who need rehabilitation at discharge.

Also, it required certain items to be developed with the involvement of the individual and/or their family/carers, and administered by a specialist healthcare professional.

For all these changes, I believe there are still flaws that need addressing.

Reports I hear from some quarters suggest that RPs are, at times, being treated as a tick-box exercise.

Everyone knows they need to complete it, but perhaps not everyone does so as comprehensively as they could.

Some consider the tool clumsy and unable to cater for the nuances of what may be a complicated and progressive rehabilitation plan.

The challenges remain where treatment bridges hospital care and the transition upon discharge home.

In many cases the RP is being completed in brief and then accompanied by a more detailed referral letter outlining the key rehabilitation challenges and objectives.

Some healthcare professionals have told me that RPs simply aren’t given the gravitas they deserve within their field or organisation, and thus don’t receive the allocated time needed to complete them appropriately.

For many, RPs have become an extra burden in an already packed weekly schedule and therefore are being rushed through.

By the time it reaches the GP, it may be a document lacking cohesion and, therefore, is arguably of limited value to them or the patient.

I recently discussed this with a group of allied health professionals and was told  that many physios, occupational therapists and other therapy disciplines are completing RPs as best they can; but still feel it necessary to include the covering referral letter.

I consider that a key component of the success of the RP is that, wherever possible, it is created in partnership with the patient, however, these documents are reportedly not always being passed to the patient.

This could be for a number of reasons, perhaps partly down to some consultants and GPs seeing little value in passing what appears incohesive information on to the patient or their family.

Communication between the treating professional may also be affecting the success of RPs. I heard from several orthopaedic surgeons at a conference event recently who said they have relatively little direct input into the RP process and the default position is to rely upon the Band 7 therapists to complete the RP.

I am of the view that it is essential that the treating consultant contributes directly to the plans formed on the RP, as they have such valuable input to offer.

They ultimately understand the limitations produced by the injury itself and the treatment or surgery they have provided.

Of course every professional involved in rehabilitation wants what is best for their patient or client; and we are all united in driving forward for better outcomes.

Is further work needed by government and national healthcare decisionmakers in reaffirming the role of RPs in achieving this?  Or are they destined to be discarded and never reach their full potential?

Should updates to the RP system be in offing? If so, I would propose one significant change.

In the modern trauma centre arena the legal profession has so much to offer in negotiating and providing resources to enable our clients to achieve their best possible rehabilitation outcome.

RPs are supposed to map out the full rehab picture for the individual, and in cases where patients have commenced litigation if solicitors can be involved in the early discussion and maybe even contribute to the RP, I am confident that so much more can be achieved.

This would be a bold step, but I believe can only be of benefit to our clients, and from a healthcare perspective represent a truly patient centred approach.

Glen Whitehead represents adults and children who have sustained life-changing injuries and also family members who have lost loved ones as a result of fatal accidents. He is based in Irwin Mitchell’s Sheffield office.