NHS Grampian Orthopaedic Outpatient Pilot

1. NHS Grampian Orthopaedic Outpatient Pilot

2. The Problem • DEMAND exceeds CAPACITY

3. New Patient Referrals 12700 Capacity 10200 • 50% increase in referrals since 1998 • Waiting list queue increasing by 200/month • Outpatient Waiting Time 34-73 weeks Hand and Shoulder 90 Weeks

4. Aim • Reduce outpatient waiting times and improve patient access by developing a new intermediate tier of care….

5. Phase 1 • Multi-disciplinary Planned Care Project Team • Review of Referral Letters

6. Phase 1 • 95% of referrals appropriate • 40-45% did not require to be seen by Orthopaedic Consultant • 100-125 new referrals/week

7. Phase 1 • Development of Intermediate Tier • Consultant Triage of Referrals • Clinical Audit • GP Communication • Initial Training

8. Phase 1 • Clinics Established • Unknowns Requirement for returns Physio referral X-ray Inpatient Waiting Times • Initial problems

9. Phase 2 • NHS Grampian wide extension • Aberdeen 3 GP’s 2 ESP’s Stonehaven 1 ESP Elgin 2 GP’s 2ESP’s (shared) Buckie 1GP Keith 1 GP Banff 1 GP

10. Results • Patients Seen 1011 Clinic intervention 216 21% X-Ray 323 32% Waiting List 64 6%

11. Results • Patients Seen 1011 Physiotherapy 374 37% Discharged with advice 483 48% Return appt GPWSI 102 10% ESP 35 3% Referral to Consultant 17 2% • Overall 85% of patients discharged

12. Future • Development of GPWSI • Long term Funding • GP sub-specialists • Podiatry Service