National MSK Redesign

1. National MSK Redesign The facts

2. What do we know? People in Scotland with MSK conditions currently experience….. • Variable access to MSK services • Variable management • Variable measurement of outcomes • And sometimes…long waits for these variable services ………………we could do so much better.

3. Where has the need to change come from? Delivery Framework for Adult Rehab, 2007 (SGHD) • Significantly redesign local MSK services • Management should be delivered by MDT teams in community settings • Health Works (2009) • NHS 24 - integral to the delivery of MSK Pathway and ‘Health Works’ • Main point of direct access into rehab and MSK services

4. Why change? Areas of innovative practice exist around accessing AHP services but by no means equitable • Huge variance in access to services….. • Post code dependant. • Inconsistency in services offered and delivered • Regular and sudden changes to existing services • No self referral in areas • Having to arrange AHP appointment only after contacting • Poor access to advice and information • Inconsistent triage of patients

5. The Scottish Offer • for any individual of working age who requires access to NHS healthcare services to address health barriers to work • include a definition of people’s functional capacity. • NHS needs to provide services support them back to work

6. The national MSK redesign consists of • Focus on local services redesigning their MSK pathway around patients • Focus on employment, the ‘Scottish Offer’ • Focus on developing a national point of access to local MSK services • Focus on developing interdisciplinary teams delivering MSK

7. What do Boards need to do? • Develop local referral hub • Develop interdisciplinary pathways • Embed outcomes measures into pathways • Ensure referral into mental health, employability and other acute services • Develop workforce • Education, training

8. Self management • Self mgmt advice • Community programmes • Web support – NHS inform • 12,000 clients NHS 24 (up to 40,000 p.a) SME + Absent >4 weeks Any joint Referrals made directly into hub from GP services and other hospital services i.e. A&E, orthopaedics WHSS 1-2% Approx 260-575 ‘NHS Lanarkshire Referral Hub’ 27,500 clients Require MSK services Phone Consultation (1st appointment) Direct appointments made at hub Shoulder pathway 15% 3,575 Hand pathway 5% 1,375 Neck pathway 10% 2,750 Hip pathway 5% 1,375 Foot and ankle pathway 15% 3,575 Knee pathway 20% 5,500 LBP pathway 30% 8,250 • All pathways will include ability to refer into the following services at any point in pathway even after first appointment / telephone consultation: • Pain Services– 8%, 1,100 • Mental Health Support – including breathing space, case management, mental health teams – 10%, 1,375 • Employability support – 10%, 1,375 • Self management – including community leisure programmes and third sector programmes – 10%, 1,375 • Rheumatology services – trigger questions agreed. – 1% 137 Patient Centred Pathway for MSK Services - example

9. Where does NHS 24 come in? • It will run a national advice and triage telephone based management resource for MSK conditions Why? • Reduce inequity • Provide speedy access to advice and information • Consistent triage of callers • Appropriate referral onto local AHP MSK services • Realise efficiencies and release frontline capacity

10. What NHS 24 will do. • Work with Boards to ensure that those patients who need to be assessed by local AHP MSK services are referred directly to them • Need to be assured that Boards have redesigned their services to ensure these referrals will be responded to in a timely manner • Direct patients who need advice and information to high quality, validated information sources

11. Programme aims • Non-emergency MSK Advice and Triage Service (In-hours, 9am – 8pm) Introduce and sustain an NHSScotland MSK Triage And Referral Management Service for patients with MSK disorders. • Out of hours Apply revised pathways for the existing people who call NHS 24’s out of hours service with an MSK condition.

12. A National MSK Advice and Triage Service for NHS Scotland • Run through NHS 24 • Patients and referrers encouraged to use but not compulsory • Patients will phone a new specific number

13. NHSScotland MSK Advice and Triage Service – New non-emergency service • Aches & Pains Direct Up to 300,000 referrals annually (240,000 adults) WHSS referral for those in paid employment & absent from work for over 4 weeks (Small-medium workplace) 30% self referrers 50% directed by GPs 20% directed from other sources Protocol Driven Advise & Refer Model Ability to identify: non-emergency (non 999, A&E) callers with sprains, strains and pains of joints and muscles Enhanced self management resources Referred to local MSK hub for access into local services New, Specific number Ability to redirect to medical services, if safety issues arise Triage and RM Model, LKH 27/3/11 vs.3

14. Approach Develop a system that is safe and sensitive enough to identify and direct those who may potentially benefit from: • AHP intervention • Self management resources • Working Health Services Scotland • 999/Accident & Emergency referral

15. Approach • This is not a full physical assessment process • It is an advice and triage system

16. Advice and Information Resources • Patients need information to support self management • Need for national resources that provide high quality, consistent information • NHS inform can fulfil that role: Scottish Backs, neck, knee, shoulder sites, VideoPhysio, PhysioTools, Back in Control

17. 2. NHS 24 MSK Model: Enhancement of Existing Out-of-hours Service 85,000 routine MSK callers per annum Existing algorithms enhanced to allow for identification of: non-emergency (non 999, A&E) callers with sprains, strains and pains of joints and muscles Estimate < 16,000 per annum WHSS referral for those in paid employment & absent from work for over 4 weeks (Small-medium workplace) Enhanced self management resources Referred to local MSK hub for access into local services 08454 242424 Ability to utilise current dispositions as required Triage and RM Model, LKH 27/3/11 vs.3

18. Out of Hours Emergency Calls • Enhancements needed to existing system • Currently 85,000 callers with MSK conditions • Some of these would benefit from being directed to AHP services • No current option to do so

19. Scottish Backs www.scottishbacks.co.uk

20. Back in Control Back in Control Welcome to Back in Control Freely downloadable from (www.scottishbacks.co.uk) An evidence based patient information booklet about back pain.

21. VideoPhysio www.youtube.com/videophysio Falls, COPD, shoulder, knee & neck pain videos coming soon.

22. MSK Newsletter fferguson@nhs.net to sign up for it. Every 2nd month

23. ….is a national service helping you to find amongst other information how to access public services and search for local information and advice. • Access to Scottish Backs and NHS inform via digital TV • Text NHS 24 to 61061 • http://lookinglocal.gov.uk/digitv/cds/nhsscotland/Netgem/home.html

24. Pathway Governance

25. Local Boards Should redesign MSK services during 2011 NHS 24 Develop national Advice and Triage service during 2011 Enhance current out of hours protocols during 2011 Systems piloted in Lanarkshire and Lothian from autumn 2011 System evaluation – Spring 2012 Report consideration and national roll out Resource pack and support When will all this happen?

26. Who’s who?