A New Musculoskeletal Pathway

Vision or Reality ?

Sarah L Mitchell, Rehabilitation Programme Manager, Scottish Government

June Wylie, AHP Professional Officer, Scottish Government

Requirements for 18 week The delivery of 18 weeks requires fundamental

service transformation and re-design - doing the same faster will not achieve the 18 week target.

Access to services needs changing– planning strategy

Demand management for orthopaedic services in primary care is key to meeting access targets

AHP’s given opportunity to deliver on improving access and the necessary referral management process

Service Transformation Service transformation will require not only the

ability to influence processes, but to change mindsets, cultures, activities, and organisational power bases.

Quote – Albert Einstein

Insanity: doing the same thing over and over again and expecting different

results.

Scale of MSK problem in UK• More than one third of the population aged over

50 have pain at any site that interferes with their normal activities.• More than 10 million adults (6 million women and

4 million men) consult their GP each year with arthritis and related conditions.

• This becomes more common with age with 1 in 10 people aged 15–24 seeking a GP consultation each year with a musculoskeletal problem rising to 1 in 3 people over 75 seeking a consultation.

Scale of problem

• 48% of work related problems in Scotland of MSK origin

• UK – 12.25 million work days lost due to MSK problems

• Costs £141 million just for GP consultations

Present model• Pathway – GP onto orthopaedic waiting list.

Many centres in Scotland patients screened by ESP’s within acute centres.

• National UK data identifies this pathway resulting in up to 70% not requiring surgical intervention.

• What does this mean for the patient? Sickness absence? Psychological problems? Reduction in functional capacity? No active management!

• Einstein!

Community Based Ortho Services A Community Based Multi-professional Triage

Team / Orthopaedic Assessment Service (OAS) – PT’s and GPwsi

A centralised referral management system – NHS 24 physiotherapy tele-health service?

All AHP musculoskeletal services to be delivered within a single system

All return clinic appointments following surgery seen by AHP MSK team

CommunityAHPMSK

Services

Integrated MSKTeam

PhysiotherapyPodiatry

OTDietician

ProstheticsRadiography

Specialist nurseGPwsi

Self Referral via NHS 24

Self management and advice

(MKN, working backs etc)

GP Referral

Walk in Self Referral

Electronic Referral

Vocational Rehabilitation

Services & Chronic Pain Services

Orthopaedicwaiting list

Rheumatologyservices

Other acute services

Electronic Referral

GP Referral Electronic Referral

Vision or Reality ?

Evidence and the benefits to support this change in service delivery

Improved access to diagnosis and treatment Reduced waiting times Improved conversion rates to surgery in secondary care –

up to 80% conversion. Greater efficiency and productivity Earlier return to work and avoidance of long term absence

and long term dependency on benefits Also support sshifting the balance of care and other

Government policies (rehab framework, patient experience etc)

Promotes a self management culture for patients in Scotland

New Pathway Requirements

Self referral/primary care referral into MSK services

Community AHP led MSK model

The future of MSK pathways requires The need to overcome professional barriers to

explore more productive and effective options

Using lessons learnt and available evidence to design services

Support to fully explore greater productivity and efficiency in delivering MSK services

Critical Success factors Professional support- Surgeons, GPs, AHPs Agreement about need for a single system MSK service Support to develop a pilot project with an NHS Board A system of in-reach into acute hospitals to allow AHP staff to

work with Orthopaedic Consultants in secondary care, while remaining primary care based

Identification of training and development needs to develop advanced practitioner skills.

Detailed evaluation plan and baseline data set to be developed before the start of the change so that the impact can be fully understood.

Identification of project resources