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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 ?