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The National Musculoskeletal (MSK) NHS Lanarkshire Pilot

The National Musculoskeletal (MSK) NHS Lanarkshire Pilot. Scottish ‘Health’ Offer – National Forum 26 th January 2012. Dr. Sarah L Mitchell National Programme Manager Delivery Framework for Adult Rehabilitation. WHY ARE WE RE-DESIGNING OUR MSK SERVICES?.

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The National Musculoskeletal (MSK) NHS Lanarkshire Pilot

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  1. The National Musculoskeletal (MSK) NHS Lanarkshire Pilot Scottish ‘Health’ Offer – National Forum 26th January 2012 Dr. Sarah L Mitchell National Programme Manager Delivery Framework for Adult Rehabilitation

  2. WHY ARE WE RE-DESIGNING OUR MSK SERVICES? • 1 in 4 GP consultations MSK related (1 in 3 for over 75’s) • More than 10 million GP consultations (MSK) each year costing £141M (UK). • 30,000 patients sitting on Orthopaedic waiting list in Scotland, with conversion to surgery as low as 11%. • 7.6 million working days lost due to MSK related conditions. • 40,000+ MSK referrals into Lanarkshire AHP Services. Patient Experiences Variation in… Access…Management...Outcomes…Waiting Times

  3. WHAT ARE WE PROPOSING?……..what does that mean for each of us? • A National MSK Triage and Referral Management Service for NHS Scotland utilising the technologies of NHS 24 • Local referral management hubs within boards • Direct referral into WHSS for those working in SME’s • Development of Interdisciplinary pathways using evidence based outcome measures • Development of algorithms within pathway to ensure correct service provision • Early identification of employability issues, anxiety depression scores • Greater utilisation of leisure facilities • Increased or Decreased workload for some of us. • Better use of clinical skills and resources. • Better patient clinical outcomes. Right Patient, right place, right time. • Some of us may have to grow our current skill set. • We all need to place high value on clinical evidence and patient outcomes. • We all need to be prepared to be held to account more as leaders.

  4. Referral pathway Current referral pathway… Proposed referral pathway… * National Advice & Triage Service

  5. NHS SCOTLAND MSK ADVICE AND TRIAGE SERVICENon- Emergency LOW RISK Enhanced self management resources, web, digital TV & APP www.nhsinform.co.uk/msk 0845 604 0001 Protocol Driven TRIAGE TOOL Ability to identify: non-emergency (non 999, A&E) callers with sprains, strains and pains of joints and muscles self referrers GP directed directed from other sources MEDIUM / HIGH RISK Referred to local MSK hub for access into local services, plus www.nhsinform.co.uk/msk WHS REFERRAL for those in paid employment & absent from work for over 4 weeks (Small-medium org) • Triage Tool • Developed by expert panel • Safe: identifies red flags • Employment: identifies WHS • Includes STaRT MSK tool: stratifies into low, medium and high risk • Hill et al www.thelancet.com 29/09/11 Ability to redirect to medical services, if safety issues

  6. MSK SERVICE REDESIGN – New Process First Contact Physio assessment (EQ5D and outcome measures) HUB A&E Mental Health Leisure First Contact Podiatry assessment (EQ5D and outcome measures) TRAK – automated letter sent to patient (and communication sent to CRMS) Older People Services Vocational Services Self Management and exit from system Employability Services Rheumatology First Contact OT assessment (EQ5D and outcome measures) Community Pharmacy 2nd AHP Appointment (intervention) Pain Services Ortho First Contact AHP telephone consultation and EQ5D Dietics TRAK / CES Info. dump

  7. Key Performance Indicators • Total MSK demand • Patient DNA rates • Patient referrals to Secondary care (Ortho surgery) • Patient waiting times • GP consultations • Investigations • Prescription charges • Patient referrals into Leisure services • Patient referrals into Employability services • Mental Health referrals • Patient experience • Functional Improvement Outcomes - If we want to find what's best for the people of Scotland we need to measure!!

  8. Monitoring Data – NHSL (Pre-pilot)

  9. Patient Experience (Pre-pilot) Highlights • 315 data entries to date were gathered from NHS (19%) and Community Links (81%) • 21% of these supplying a postcode which falls into the top 15% of deprived areas in Scotland as indicated by the SIMD 2009. • 28% Post and 72% street questionnaires.). • 97% of participants stated that their ethnic background was white. • top three most commonly cited MSK problems are currently identified as back (39.3%), Knee (25.2%) and shoulder (21.3%). • 86% of people indicating that they had an MSK related problem, attended their GP • 22.8% of patients who attended GP appointment waited 3-4 weeks and 22.8% waited more than 12 weeks for MSK appointment. • 90% of individuals indicated that they did not receive any help from other non NHS services • 24% of people were aware of the PAL service which operated and of those that were aware of the help line and had used it, 32.5% found it very useful and 23.4% found it quite useful. • 94% indicated that they had followed some or all of the advice given to them during treatment. • 83% of people felt that they were given enough information on how best to manage their conditions • 86% of patients unemployed at the time of their problem stated that they had no discussions with NHS staff on the benefits of employment for their health. • 42% of patients in employment felt that treatment received had made a big difference in helping them stay at/or return to work more quickly. • 64% of employed patients recorded that they were absent from work because of their muscle or joint problem. The most common period of sickness was cited as being between 1 and 2 weeks. • Over 77% of people reported that their health had improved moderately or significantly as a result of MSK care services. • 79% of individuals were likely to recommend services received to friends and family. • 63% of participants that received NHS treatment for their MSK problem stated that they would either be quite or very likely to use a new interactive service linked to self management. • 28% of individuals stated that they had received information from NHS staff on other support services. Again GP’s were cited as the most common source of information.

  10. NHSL PHYSIOTHERAPYNew Attendances / New DNA / New DNA %Time: 01/04/2010 – 31/3/2011Split: Locality

  11. NHSL PHYSIOTHERAPYReturn Attendances / Return DNA / Return DNA %Time: 01/04/2010 – 31/3/2011Split: Locality

  12. NHS Lanarkshire – Lower Back Pain (LBP) Analysis Straight to Leisure

  13. LEISURE REFERRALS12 months projection Projecting over 700 additional Leisure referrals in first 12 months

  14. NHS Lanarkshire – Physio Waits Current>Projected Pysio Weeks Wait Data Input Last Friday of Month Target Pysio # Patients Waiting Data Input Last Friday of Month

  15. NHS Lanarkshire - Orthopaedic Demand2010 vs 25% Reduction - Over 3000 Ortho Patient Demand Reduction

  16. Equally Well Process

  17. MAJOR DELIVERABLES • Equitable access for MSK patients to appropriate management options • Consistent, high quality information and advice • Information developed and adopted across NHS Scotland • Enhanced user experience • True health/employability pathway • Wider Cost Benefits – Full economic analysis

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