Download Benefits Realisation - Matrix

MSK Service - Pathways
Cathy Dunn - NHS Lanarkshire
19th May 2010
NHS LANARKSHIRE MSK PATHWAY
PATIENT
PATIENT
ASSESSED AT 1:1
PHYSIOTHERAPY
APPOINTMENT
ACUTE
GP
PATIENT
ASSESSED AT 1:1
PHYSIOTHERAPY
APPOINTMENT
PRIMARY CARE
5,712
22,712
ORTHOPAEDICS
ESP VET
ESP:
· General (3)
· Spinal (3) - 2784
· Podiatry (1)
· Appliance
17,000
Consultant
NHS Lanarkshire Challenges
•
Multiple access routes
•
Duplicate referrals (physio and orthopaedics)
•
Multiple handoffs from ESP to Physio and ESP to Consultant and Consultant to
spinal Surgeon = multiple waits
•
Not compliant with evidence base
•
Ortho consultancy and ESP capacity used inappropriately
Against a backdrop of increasing orthopaedic demand
NHS LANARKSHIRE PROPOSAL MSK MODEL – BACKPAIN PATHWAY
DISCHARGED –
SELF
MANAGEMENT
DIRECT ACCESS
PHYSIOTHERAPY
(TELEPHONE
ADVICE LINE)
PATIENT
REFERRED TO
VOCATIONAL
REHAB (CASE
MGT)
GP
PATIENT
ASSESSED AT 1:1
PHYSIOTHERAPY
APPOINTMENT
ACUTE
Approach
Develop a Model which supports all
MSK clinical pathways and initially
focuses on our key demand areas:
- Spinal
- Knee
Key to this success is a
LEAN spinal pathway
Via protocol e.g. red flag cancer, infection
PATIENT
ASSESSED AT 1:1
PHYSIOTHERAPY
APPOINTMENT
PRIMARY CARE
ORTHOPAEDICS
CONSULTANT
Spinal ESP
Process Owner
Value Enabler
Re-profile ESP Team:
• Identify a spinal ESP process owner to implement the clinical pathway
and support the model
•
Convert the remaining 2 spinal ESP (No longer required) to a general
caseload
•
Increase in capacity for general MSK will provide an additional resource
to orthopaedic outpatient
Impact on Services
Physiotherapy
• 2400 patients will be redirected via Direct Access
• Deduct 780 (previously re routed to physio from ESP)
• 1620 would be the maximum impact in terms of physiotherapy
assessment (quantify additional resource)
• Shared Resource of Spinal ESP
Orthopaedic
• Orthopaedic ESP Capacity Gain
• 2400 – 600 (Spinal ESP ?may be used in pc/a)
• 1800 slots gained for general MSK
Benefits Realisation - Matrix
Patient experience / safety
– Evidence base clinical management and treatment utilising competency
based package
– Prevention of chronicity by more timely intervention
– Promotes self management and empowers the patient
– Improve patient experience right clinician at the appropriate point on the
pathway
HEAT and Performance Management
– Waiting times
• reduces wait for Consultancy
• reduces 18 week RTT pathway non admitted and admitted
– Primary Care Access
• No wait for GP appointment
• Single point of access for low back pain
– Reduce DNA’s eliminating waste
Benefits Realisation - Matrix
•
Efficiency Productivity
– Improve efficiency and productivity of consultants, ESP and
Physiotherapist
– Utilising existing accommodation and manpower resources
– Avoids waste and maximises skills and expertise
•
Quality of healthcare for patients
– Timely, effective, safe, efficient (avoid waste), equitable
– National performance framework –participation in labour market through
improved health and social factors.
– North Lanarkshire – unemployment rate 7.9% (Scotland 5.9%) 22.4% of
population claiming benefits (Scotland 17%).
– South Lanarkshire – unemployment rate 4.2%, 19% population claiming
benefits.
Benefits Realisation - Matrix
•
Cost avoidance / reduction
– Reduces the requirement for waiting list appointments
– Reduces the cost per case for patients
– Physio resource is required to value enable the process
•
Pathway redesign would reduce if not remove the need for costly
waiting time clinics, faster access to care. (cash saving)
BALANCED SCORE CARD
Financial
•Invest into Physiotherapy to
support revised pathway.
Customer
•Advice and self management
strategy given (3 days) via DA
Physio phone line.
·Managed clinical pathway for
back pain in accordance with
national guidelines and
evidence base.
·Reduces the need for GP
consultation for low back pain.
·Reduce waiting list initiative
costs through multidisciplinary
team approach within outpatient
clinic.
·Overall saving
Vision
and
Strategy
·Reduction in number of clinic
attendances for patient.
·Provide continuity and equity
of care.
Learning and Growth
•Develop Consultant and ESP
professional relationship.
•ESP’s to develop new skills.
•Evidence based training with
physiotherapy linked to KSF.
•Informed/appropriate referral can
be made first time, every time.
Internal Business Processes
•Agree single point of access
for low back pain referrals.
·Develop competency / training
package for Physio services to
ensure equity of care
·ESP resource shift to Primary
Care to manage back pain
clinical pathway.
·Agree MDT approach to
delivering outpatient services.
·Consultant and ESP combined
E-Vet.
·Re-profiling ESP clinic profiles
to support multidisciplinary
team working.
·Performance Monitor/Manage
DCAQ realtime.
ANY QUESTIONS ?