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SCHEDULE 2 - THE SERVICES
Schedule 2 Part 1: Service Specification
SERVICE SPECIFICATION
Service
Commissioner Lead
Integrated Musculoskeletal Clinical Assessment and Treatment Service
Emma Haffenden – Commissioning Portfolio Lead, NHS
Buckinghamshire
Tim Jones – Project Director, United Commissioning
Provider Lead
Period
Document information
This is a draft service specification drawn up to support the procurement process. Every effort has been
made to ensure that the information in this specification is accurate and it is our expectation that the final
specification to be included in the service contract will be substantially the same as this document.
However, the commissioners reserve the right to alter this specification up to the point of commercial
close.
The provider should take careful note of the statements that are prefaced by the text ‘The provider will:’
and are highlighted in bold, italic text as these will form contractual requirements and/or inform the
performance framework.
Where text or other material is not complete or is likely to change a note has been included in [bold text
with square brackets]
1. Purpose
1.1 Aims
The purpose of this specification is to set out the requirements for an integrated clinical
assessment and treatment service for people with musculo-skeletal complaints.
This will serve as an alternative to hospital based treatment for the majority of patients being
referred by general practitioners for musculoskeletal (MSK) assessments and for the
management of pain that is not neuropathic in origin. Patients w i l l be referred to hospital
only when there is a need for hospital based specialist services.
The aim is to manage musculoskeletal conditions within an evidenced-based model with an
emphasis on supported self-care, improving the quality of services and clinical outcomes,
reducing waiting times and increasing access for patients and provide value for money.
The service should be provided in accordance with a set of principles that encompass these
aims. These principles will guide the provider and commissioner in all aspects of service
delivery and will be used to inform the performance management of the service.
The provider will:

Place the patient at the centre of design and delivery of an integrated service

Be committed to close cooperation with all others on the clinical pathway, individually and
as an organisation

Fit closely with good quality management of MSK by primary care. It is not the intention
that the service should take over from care by GPs

Work to maximise integration of the service in a way that gives a high quality patient
experience and avoids duplication (e.g. multiple assessments)

Promote interdisciplinary team care and the Single Assessment Process (SAP) to ensure
that an individual’s support needs are considered in a holistic way

Support a unified care record

Identify organisational barriers to the delivery of patient-centred care and address these
1.2 Evidence Base
Clinicians are expected to keep knowledge and skills up to date throughout their working lives and be
familiar with relevant guidelines and developments that affect their work (Good Medical Practice, General
Medical Council, 2006). This principle extends to all staff engaged in the provision of the service. A
commitment to evidence-based practice should be demonstrable through the presence of effective
systems, policies and resources.
The provider will:

Promote the use of evidence-based practice

Provide a consistent decision support system for all professionals, including trainees

Ensure effective clinical governance and support multidisciplinary clinical audit
The evidence base for effective practice is changing constantly and it is not helpful to offer a definitive
list of guidance. However, at the time of writing the following publications and standards are
particularly relevant:

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The Musculoskeletal Services Framework, DH 2006
NICE Guidance, Osteoarthritis: The Care and Management of Osteoarthritis in
Adults. Feb 2008
NICE Guidance, Rheumatoid Arthritis: The Management of Rheumatoid Arthritis in
Adults. Feb 2009
NICE Guidance, Low Back Pain CG88
Lamb et al. Best back education skills training trial published in Lancet 2010
Healthcare Commission — Core Standards
The Chartered Society of Physiotherapy and professionals including Occupational
Therapists, psychologists, Nursing staff and podiatrists — Core Standards and service Standards
The British Pain Society – Guidelines for Pain Management Programmes for adults,
April 2007
1.3 General Overview
In England, as in the rest of the world, musculoskeletal conditions are common, and are a major cause of
ill-health, pain and disability. It is estimated that nearly one-quarter of adults and around 12,000 children
are affected by longstanding musculoskeletal problems, such as arthritis, that limit everyday activities.
Musculoskeletal conditions are the most common reason for repeat consultations with a GP, making up to
30% of primary care consultations. The prevalence of musculoskeletal conditions generally rises with age
and, since the number and proportion of older people in the population is projected to increase in future,
so the number of people with musculoskeletal conditions will also rise. However, the functional
impairment from musculoskeletal conditions varies widely depending on a variety of physical and
psychosocial factors. (Musculo Skeletal Framework, Department of Health, 2007)
At present, musculoskeletal services are provided for Buckinghamshire registered patients by:
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
a community based physiotherapy service(across 7 sites plus outreach to local leisure centres
and some GP surgeries) receiving referrals from GPs and other community practitioners,

Hospital physiotherapy service which is located at Amersham Hospital, Stoke Mandeville
Hospital and Wycombe Hospital providing physiotherapy to BHT consultant referrals

MSK ICATS (limited scope) provided by Vale Health in conjunction with community based
physiotherapy service

Chronic Pain & Fatigue Management Service based at Rayners Hedge and Amersham Hospital
provided by the community and Integrated Care division of BHT

Hospital based care (Trauma & Orthopaedics, Rheumatology and Pain Services).
1.4 Objectives
The service will have the following objectives:

Improve patient access to MSK services by establishing a community based service and
improve the patient experience through improvements in patient satisfaction.

Ensure patients are seen and treated in an environment most appropriate to their needs.

Develop agreed models of care and pathways for common musculoskeletal conditions.

Achieve a reduction of 40% in orthopaedic, rheumatology and pain management referrals to
acute hospital providers.

Increase conversion rates from outpatient attendances to surgery through more appropriate
referrals to acute hospital providers.

Reduce waiting times for patients and assist in maintaining the target of a maximum 18
week period from referral to treatment.
1.5 Expected Outcomes
The service will have the following expected outcomes:
[To be agreed in consultation with the provider at contracting stage]
2. Scope
2. Scope
2.1 Service Description
Evidence from other similar initiatives has shown that a separation of ICATS services from primary and
secondary care clinicians can have a serious impact on service quality and patient experience. The
provider will be required to demonstrate that their service is integrated and that there is real and
continuous effort to remove any barriers to effective care and providing a high quality patient experience.
How this is achieved is at the discretion of the provider. This aspect of the service will be subject to
performance review.
Referral and assessment
Patients will access the service via three routes:
1. Referral from general practitioners based in NHS Buckinghamshire
2. Referral from other clinician e.g. A&E departments, and non NHS specialists
3. Self-referral
The referral can be via choose and book or a paper proforma which can be faxed or posted to the service.
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If the referral is via the paper proforma the service will transfer the patient details to choose and book.
The patient will ideally present with adequate information on which to make clinical assessment as to best
destination. Wherever possible the provider should arrange onward care based on this information.
However, some referrals will be poor quality, with inadequate information or no information in the case of
self referred patients. In these cases in which case patient should be contacted and additional information
obtained. This may be through a questionnaire to complete followed by a telephone conversation
The provider will:

Carry out an assessment of the patient based on information available at referral

Obtain additional information if required

Arrange onward care
If, following a paper triage of a referral, the triaging clinician is of the opinion that the patient
should be referred directly to an acute hospital, the referral will be sent back to the GP immediately so
that the GP can offer the patient a choice of provider and book the appointment using the Choose and
Book system. The GP will be notified of the reason(s) why the referral should have been made directly to
an acute hospital. The GP should be notified by FAX if this is the case to avoid any further delay
Diagnostics
Plain film x-rays should be provided as an integral part of the patient assessment without the need for the
patient to make a further appointment. Other diagnostic investigations s h ou l d b e ac c es s e d v i a
ref err a l. A list of the treatments and activities included in the service is given at Schedule 2 Annex 3.
The provider will:

Access appropriate diagnostic imaging and other tests on behalf of the patient

Will ensure that results/images are received and used in an appropriate and timely was to
manage the patient

Ensure that all images/tests are carried out in a timely way to optimise patient care

Work closely with providers of diagnostic services to promote integration and ensure a
high quality patient experience
Treatment
The service will be able to assess a wide range of musculoskeletal conditions and make a diagnosis in
order to deliver effective, evidence and outcome based management plan. The service will also forge
appropriate links with the third sector support and advice groups to offer patients ongoing support if
appropriate.
A see and treat philosophy is at the heart of this service. It is not intended to act as a referral
management centre or gatekeeper or additional tier of service between primary and secondary care.
Instead the service will accept referrals and organise care accordingly, referring onward where
appropriate. A list of the treatments and activities included in the service is given at Schedule 2 Annex 3.
Shared management with the patient’s GP
The interface between primary care and the ICATS service must be well-managed if the service is to be
truly integrated. GPs will continue to provide comprehensive and holistic care for people with musculoskeletal conditions and will continue to be able to access a range of diagnostic and other tests to support
their management of the patient.
The provider has an important role to play in ensuring that the ICATS service is used to its optimum.
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The provider will:

Have due regard for the reasons given by a GP for a referral in the assessment and
treatment of the patient

Provide data to GP practices on their utilisation of the service

Provide information to practices to help them improve the quality of patient referrals, in
particular:
o the completeness of referral forms/letters
o any instances where patients have been referred inappropriately

Manage discharge appropriately (see section 5)

Devise and run a programme of educational events to include the management of the
primary care/ICATS interface. The provider should maximise opportunities available of
existing programmes, meetings, resources, etc.
Prescribing and dispensing
There are circumstances when it will be appropriate to prescribe and dispense medicines. The provider
will have the required clinical expertise to stock relevant medicines from the agreed formulary in their
clinics. A list of the medicines that may be prescribed and dispensed will be agreed (the formulary) .
The provider will not hold or dispense controlled drugs.
Prescribing decisions and recommendations will only be made by suitably qualified medical independent
prescribers.
The provider will:

Offer patients appropriate medication at assessment where this is indicated. Medication is
likely to comprise analgesia

The supply of medication shall be 28 days unless otherwise agreed

Have appropriate clinical governance procedures in place including a clinical governance
lead that will ensure that all prescribing is within national and locally agreed guidelines
and treatment pathways.

Agree with the commissioner the formulary
Management of complex/chronic MSK pain
The service will include a chronic pain management service. This will combine physical and
psychological pain management programmes for people who have had chronic, including low back pain
for anything more than six weeks who have significant psychological distress and or disability and who
have had a trail of exercise, acupuncture or manual treatment.
The provider will:

Work to clear criteria and tools for determining whether patient is at risk of chronic pain
with attendant disability and social care costs

Provide a multi-disciplinary pain programme to include:
o
Physical therapy
o
Occupational therapy
o
Psychological interventions
o
Medicines management interventions
o
Likely 8 - 10 sessions
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Onward referral
If assessment by an orthopaedic surgeon is required the patient will undergo a screening process (BP,
urine analysis, BMI) and be offered a choice of surgical provider. When patients are referred on it will be
stipulated in the referral the reason for referral i.e. for surgery, a surgical opinion, or because of serious
pathology.
The provider will:

Take responsibility for the patient’s experience of onward referral

Ensure that imaging and other clinical information is made available to the service to
which the patient is being referred

Apply prevailing guidelines in respect of treatment thresholds and priority treatments

The patient is booked directly into surgical lists unless excepted on clinical grounds
Discharge
See section 6.
2.2 Accessibility/acceptability
Referral criteria are listed below in paragraph 4.4.
2.3 Whole System Relationships
The success of this service will depend on the provider developing good relationships with all those on
the pathway for musculo-skeletal care. This is a core aim and principle of the service. See other sections
especially Section 3.
2.4 Interdependencies
The success of this service will depend on the provider developing good relationships with all those on
the pathway for musculo-skeletal care. This is a core aim and principle of the service. See other sections
especially Section 3.
2.5 Relevant Clinical Networks and Screening Programmes
None at the time of writing
2.6 Sub-contractors
The provider may subcontract elements of this service.
The provider will:

Retain liability for all aspects of service delivery and may not transfer this liability

Ensure all sub-contracting arrangements are documented

Make available to the commissioner all relevant information to the commissioner relating
to sub-contracted arrangements. This will include, for avoidance of doubt, any
information that might be considered as commercial in confidence
3. Service Delivery
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3.1 Service Model
3.1.1 Provide a high quality patient experience
The provider will place the patient at the heart of the service at all times. The provider will take
responsibility to ensure that the patient receives an integrated service.
Provision of evidence-based treatment
New evidence for effective treatment should be identified, considered and used to inform clinical
practice.
The provider will:

Offer patients treatment that complies with NICE health technology assessments at all
times. Where the provider is not able to do this they must clearly highlight this to the
commissioner in writing

Have a system in place to promote use of best practice among staff. This might include
training, CPD,

Have in place a system to review clinical evidence as it emerges and to introduce this into
clinical practice without untoward delay
Promotion of self-care
Self-care and supported self-care are essential components of effective musculo-skeletal care. See
section 6.
Engaging patients
See also section on Self-care. Engaging patients in the design of services and in improvement of the
patient experience should be integral to a high-quality, integrated service. Precisely how this is done is at
the discretion of the provider however the commissioner does have some minimum expectation and will
expect all activities to be auditable:
The provider will:
 Establish a website and portal to provide information to patients, clinicians and other
stakeholders. An example of the type of web site is provided on the link below:
http://www.eckcommunityservices.nhs.uk/main-menu-pages/your-services/specialist-clinicalservices/integrated-musculoskeletal-services.aspx

Make arrangements to carry out patient satisfaction surveys and co-operate with such
surveys that may be carried out by the commissioner. The provider shall have regard to
any Department of Health guidance relating to patient satisfaction surveys.

Use a validated tool to demonstrate clinical benefits of the service. The commissioner
expects that this will take the form of a 'before-and-after treatment' assessment tool

Collect all data in a way that is auditable and such that the commissioner is able to
request regular or ad hoc reports

Be expected to demonstrate evidence of having used data and information collected from
patients to make improvements to service delivery

Co-operate with all reasonable requests by stakeholders (including commissioners,
patient groups, local authority/public health) for discussion on service quality and patient
experience
Quality standards and clinical governance
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As with all NHS services the compliance with delivery of services in accordance with Good Clinical
Practice (General medical Council, 2006) is a minimum requirement. Where a standard or document is
cited this shall include all subsequent revisions or successor standards or bodies
The provider will:

Comply at all times with core standards in ‘Standards for Better Health’ July 2004 or with
its

Have plans in place, shared with the provider, to achieve the 13 ‘developmental’ standards

Comply with relevant Health technology Assessments (guidance) issued by the National
Institute for Health and Clinical Excellence. Where the provider is not able to do this they
must clearly to the commissioner that this is so and the reasons in writing without undue
delay

Work to agreed local Integrated Care Pathways and agreed shared protocols and
guidelines.

Comply with the clinical governance framework agreed by the commissioner and to
function under agreed operational and clinical policies.

Have in place clear policies aimed at managing risk and procedures to identify and remedy
poor professional performance.

The provider will have in place a comprehensive and auditable system of clinical
governance. This is likely to include:
o A Clinical Governance Lead to liaise with a NHS Buckinghamshire designated
clinical lead
o Incident reporting
o Infection control
o Significant Event Analysis
o Managing Alerts
3.1.2 Manage demand effectively
One of the objectives of the service will be to ensure that patients are seen by a health professional in a
setting that is appropriate to their needs and offers best value for money.
The provider will:

Devise and run a programme of educational events to include the management of demand.
The provider should maximise opportunities available of existing programmes, meetings,
resources, etc.

Provide structured, systematic and regular feedback to referrers on the quality of their
referrals. This might include numbers of referrals, rates per number of registered patients,
disposal of referrals

Include systems to audit compliance with agreed treatment guidelines both within the
service and along the whole MSK pathway

Record sufficient information about their activities and be able to report on the
management of all patients
3.1.3 Ensure a high quality workforce
The provider is to be given the maximum freedom to use staff in a way that meets the requirements of this
specification.
Staffing levels
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Staffing levels and skill mix are at the discretion of the provider.
The provider will:

Have the appropriate levels of competent staff in order to:
o
Meet fluctuations in demand
o
Maintain required waiting times for patients
o
Properly assess all patients referred to the service
o
Provide all treatments set out in this specification at all times, without the necessity
for referral to other services (See appendix)
Employment status
Employment and contracting arrangements for staff are at the discretion of the provider.
The provider will:

Ensure that all staff are eligible to work in the United Kingdom

Take responsibility for all actions and practice of all staff and will not be able to transfer any
liability for service delivery to any third party

Ensure that personnel providing the service through the contract have appropriate l
indemnity cover to meet in full, claims made against them as individuals. Proof of cover of
the provider must be submitted to the commissioner on request.

Ensure that its workforce is able to meet the needs of the service including taking account
of:
o
Professional registration
o
Criminal Records Bureau checks
o
Appropriate skills and qualifications
o
Mandatory training
o
Training and development plans
o
Making sure the clinical workforce is able to meet the needs of the patient
Staff development
The scope and nature of staff development programmes is at the discretion of the provider.
The provider will:

Ensure that will have an approach to staff development that is consistent, transparent and
amenable to audit

Ensure that all staff are adequately trained to perform their duties

Ensure that staff development is carried out in a way that contributes to the delivery of a
high quality service in accordance with this specification

Ensure that staff development programmes are auditable at review

Ensure that there is adequate clinical supervision at all times
3.1.4 Ensure infrastructure that is fit for purpose
An integral service will need to rest on a sound infrastructure that supports the aims of the service.
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Comprehensive clinical record system
An essential component of any service is a clinical record system that captures all relevant clinical data
and makes this available in way that supports high-quality, integrated care. An essential secondary
function of such a system is the provision of information to allow proper monitoring of service quality,
service development and demonstration of value for money.
The provider will:

Maintain a comprehensive electronic record of care for every patient

Hold records on a single database to support service quality and improvement

Utilise the information to improve the quality of care

Utilise the information to maintain clinical governance

Utilise information in planning service improvements

Record all relevant clinical and other information according to a data set to be agreed with
the commissioner

Provide regular and ad hoc reports on service performance as agreed with the
commissioner
Information Governance
High standard of information governance are essential wherever patient identifiable information is
collected, processed and stored.
The provider will:

Will make sure that information relating to patients is managed and safeguarded according
to the law and to NHS good practice

Ensure that every patient is given the opportunity to consent to their data being accessed
for secondary use (e.g. service improvement, contract monitoring, etc)
Information Technology
Organisations providing services to the NHS are required to work within a framework that promotes
increasing integration and standardisation of NHS information and communications systems.
The provider will:

Work in ways that support national and local programmes and utilises IT in ways that
maximise patient care. The Provider will have regard to:
•
Connecting for Health
•
Choose and Book
•
Communication and use of e mail systems

Be N3 compliant, be registered with an Information Governance Statement of

Compliance (IGSOC) and through registration Authority enable the use of smart cards.

Will publish their Directory of Services (DOS) on the Choose and Book system.

Participate in PCT audits and data collection and adherence to record keeping.
Review of the service
The specification will be jointly reviewed by the provider and commissioner with regard to its
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effectiveness and suitability for patients from time to time. In no way should this service specification
preclude the provider from innovating and/or developing new ways of working.
Premises and equipment
Adequate and appropriate equipment should be available for the clinician to undertake the
procedures chosen, and should also include appropriate equipment for resuscitation.
The provider will make sure that it has a Business Continuity Plan so that if there are problems
with the clinic location or staffing, patients can still access the service.
Text to be moved
Disabled Access
The provider will ensure that wheelchair users and people with poor mobility are able to access services
(meeting DDA requirements at all clinical sites).
4. Referral, Access and Acceptance Criteria
4.1 Geographic coverage/boundaries
The service should be available to the patients of all practices in NHS Buckinghamshire.
4.2 Location(s) of Service Delivery
Patient telephone booking, patient telephone assessment and assessment/triage of clinical
correspondence - location not specified
Patient face-to-face assessment including x-ray must be delivered from one or more sites within the
NHS Buckinghamshire area. Precise locations are not specified but service must be provided with
due regard to:


Travel time via private car maximum 40 minutes
Access via public transport - no more than 5 minutes walking time from bus stop
All diagnostic services should be available from providers within the NHS Buckinghamshire area.
Patient treatments (following assessment) including physical therapy should be delivered from a
range of convenient locations within NHS Buckinghamshire area. Precise locations are not
specified but service must be provided with due regard to:


Travel time via private car maximum 30 minutes
Access via public transport - no more than 5 minutes walking time from bus stop
Currently this element of the service is provided from a number of locations. Any change in the
number or location of service delivery points may be determined as a major service change. The
provider should therefore consider the following as preferred delivery points:



High Wycombe
Marlow
Aylesbury
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


Buckingham
Chalfont/Chesham
Amersham
The provider will:

consider the suitability of service delivery points with regard to:
o
o

Therapeutic environment
Access for patients with a disability
Obtain the views of patients on the location and suitability of service delivery points
and makes changes as required
4.3 Days/Hours of operation
Hours of operation are at the discretion of the provider. The provider will ensure that some services
are provided outside core (9am to 5pm) working hours every week that the service operates.
Services will operate every week of the year unless agreed in advance by the commissioner. The
service could be available on weekends or Public Holidays.
The provider will:

Consider the service opening hours with regard to:
o
o

Patient demand as evidenced by call volume and requests for appointments
Achievement of waiting time targets
Obtain the views of patients on opening hours and makes changes as required
4.4 Referral criteria & sources
The service will accept all referred patients and all self-referred patients unless excluded (see 4.6)
4.5 Referral route
The service will be available to all patients registered with a GP in NHS Buckinghamshire
Patients will be able to self-refer to the service
Other clinicians and service providers will be able to refer patients or to direct patients to self-refer to
the service.
The provider will:

Ensure that the service is specified on the Service Directory
4.6 Exclusion Criteria
Patients should not be referred to the service where they:
 Are not registered with a NHS Buckinghamshire GP
 Have not reached their 16th birthday
 Require emergency treatment
 Have with suspected cancer
 Have post operative or post traumatic complications
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The service should not be used for patients who have:










‘Red flag’ symptoms - these patients should be referred directly to an acute hospital,
including severe pain or constant pain, day and night
Pain associated with significant trauma
Joint instability where there would be no benefit to the patient in undergoing therapy
Patient has a past history of related cancer- red flag
Systemic steroids as declared in the GP letter of referral, or discovered at first consultation
in the service
Systemic illness (fever, malaise, rigors)
Significant weight loss suggestive of serious infection or malignancy as declared in the GP
letter of referral, or discovered at first consultation in the service
Persisting severe restriction of lumbar flexion
Widespread neurology with or without upper motor neurone signs
Structural deformity
Exceptions to the exclusion criteria are set out below:
 A patient who does not quite fall into the above but nevertheless in the opinion of the
referrer there is a clinical case to exclude serious life threatening disease such as cancer
(The referrer should indicate on the proforma that in their opinion the referral is not suitable
for CATS.)
 A patient with a very high BMI, with significant co-morbidities or with high ASA scores
should be referred into the service only if the referring GP (and subsequent clinical
assessment) considers it appropriate; if this is not clear, the provider should refer back to
the GP
The provider will:

Have in place clear policies for managing patients that are excluded or otherwise not
suitable for treatment by the service

Ensure that all staff are aware of policies and audit practice
4.7 Response time and prioritisation
All referrals will be dealt with on a first-come, first-served basis. The service will assess patients and
may allocate appointments based on clinical need.
Referrals to the service will be assessed as soon as possible by the provider, with all new
appointments following a GP referral taking place no more than our weeks from the date the GP
referral was received by the provider, unless the patient chooses to attend at a later date (after being
offered at least two different appointment dates and two different appointment times within the four
weeks).
Performance of the provider on response and waiting times will form part of the performance review
of the service.
The provider will:
 Work to ensure that waiting times are kept as short as possible
 Ensure that response and waiting time standards and that any breaches of standards are
reported to the commissioner in a timely way. Standards are set out in Schedule 2
Annex 2
5. Discharge Criteria & Planning
Timely and well-supported discharge, with effective onward communication is central to an integrated
service and high-quality patient experience.
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The provider will:
 Make available to the patient’s GP a summary of care including such information as is
necessary for management of the patient. This will be in the form of a printed electronic or
paper document
 Ensure that discharge summaries are dispatched to the patient’s GP within the agreed
response time – see Schedule 2 Annex 2 for response standards
6. Self-Care and Patient and Carer Information
Promotion of supported self care
Supported self-management needs to be a guiding principle for this service, informing all aspects of
service delivery, most importantly patient interaction.
The provider will comply with good practice on supported self-care. How this is incorporated into
operating procedures and day-to-day practice is at the discretion of the provider. However, we would
expect the following activities to be part of service delivery in a way that is auditable at performance
review:
The provider will:

Offer a comprehensive range of patient information on musculoskeletal conditions,
including advice on self-management, and will direct patients to other resources as
appropriate

Will ensure that clinicians having contact with patients should be trained in shared
decision-making with regular updates

Give relevant information to patients as to what services to access should a treatment
complication arise outside these normal hours

Make available all relevant information resources to GPs. The provider may recover the
costs of producing this material
Information to support choice of treatment
Patients will be given an explanation of their condition and advice about all management options which
will be discussed with the patient including non surgical and surgical (if appropriate).
The provider will:

Discuss with the patient relevant treatment options and will make the patient ware of
prevailing policies on procedures of limited clinical value

The provider shall discuss with the patient

This provider will make available to patients the agreed procedure for booking
appointments and the policy on DNAs and cancellations.
Information for carers
The provider will ensure that information is provided for carers that supports the philosophy of supported
self care. The requirements set out in the section above will apply also to carers
7. Quality and Performance Indicators
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Service aspect
Quality and
Performance
Indicator(s)
Threshold
Method of
Measurement
Consequence of
Breach
HCAI Control
Service User
Experience
Improving
Productivity
[All quality and performance indicators will be devised in collaboration with
the service provider at contracting stage. However the provider should take
careful note of the statements relating to quality and performance elsewhere
in this specification. These will be used to inform the final indicator set]
Access
Personalised Care
Planning
Outcomes
Additional
Measures for
Block Contracts:[All quality and performance indicators will be devised in collaboration with
the service provider at contracting stage. However the provider should take
careful note of the statements relating to quality and performance elsewhere
in this specification. These will be used to inform the final indicator set]
8. Activity
Activity Performance
Indicators
Threshold
Method of
Consequence of
measurement
breach
[Activity targets and expectations will be agreed in
collaboration with the service provider at contracting
stage]
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Activity Plan
See Schedule 2 Annex 1
9. Continual Service Improvement Plan
There is no separate requirement for a plan of this type. Ongoing service improvement will form part of
the performance and review process.
10. Prices & Costs
10.1 Price
[Activity prices and costs will be agreed in collaboration with the service provider at contracting
stage]
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Schedule 2 Annex 1: Summary of Activity Plans
Page 17 of 21
Schedule 2 Annex 2: Summary Quality and Performance Indicators
Response and waiting times
[All response and waiting times to be agreed with the provider at contracting stage]
Definition
Response time
Telephone answer
Contact patients who have been referred or have self-referred to
offer an appointment
Offer of (first) assessment appointment
Offer of treatment (first after assessment) appointment
Dispatch of discharge information
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%
achievement
Schedule 2 Annex 3: List of treatments and activities
This list states which treatments and activities are to be provided in this service and which are to be
accessed via referral or other means. [This list is subject to final agreement]
Activity
Initial assessment of referrals (paper) MSK
Initial assessment of referrals (paper) Rheumatology
Initial assessment of referrals (paper) Orthopaedics
Initial assessment of referrals (paper) Pain (MSK)
Initial assessment of referrals (paper)Physiotherapy
Initial assessment of patient (face-toface) - MSK
Initial assessment of patient (face-toface) - Rheumatology
Initial assessment of patient (face-toface) - Orthopaedics
Initial assessment of patient (face-toface) - Pain (MSK)
Initial assessment of patient (face-toface)- Physiotherapy
Type
Status
Assessment
Provide
Assessment
Provide
Assessment
Provide
Assessment
Provide
Assessment
Provide
Assessment
Provide
Assessment
Provide
Assessment
Provide
Assessment
Provide
Assessment
Provide
Injection soft tissue - joint (except spine)
Injection intra-articular
Injection - image guided
Injection - spine
Procedure
Procedure
Procedure
Procedure
Neurophysiology - nerve conduction test
Procedure
Physical therapy - physiotherapy
Physical therapy - physiotherapy (to
include exercise)
Physical therapy - osteopathy
Physical therapy - osteopathy
Physical therapy - chiropracty
Assessment
Order test and manage
according to result
Order test and manage
according to result
Provide
Order test and manage
according to result
Order test and manage
according to result
Order test and manage
according to result
Provide
Provide
Refer
Refer
Order test and manage
according to result
Provide
Treatment
Provide
Assessment
Treatment
Assessment
Provide
Provide
Provide
MRI scan
Imaging
Dexascan
Imaging
Plain film x-ray
Imaging
Ultrasound
Imaging
CT scan
Imaging
Other specialised imaging
Imaging
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Physical therapy - chiropracty
Acupuncture
Acupuncture
Bio-mechanical aids - splints, collars, etc
Bio-mechanical aids - splints, collars, etc
Mobility aids - mechanical only
Mobility aids - mechanical only
Orthotics
Orthotics
Multi disciplinary management of MSK
pain
Multi disciplinary management of MSK
pain
Pain management
Pain management
Rheumatology
Rheumatology
Orthopaedics
Orthopaedics
Surgical procedures requiring general
anaesthetic
Prescription of non-opioid analgesics
Prescription of infused medicines - nonexcluded drugs
Administration of infused medicines non-excluded drugs
Prescription of infused medicines excluded drugs
Administration of infused medicines excluded drugs
Prescription of injected medicines - nonexcluded drugs
Administration of injected medicines non-excluded drugs
Occupational therapy
Occupational therapy (including home
adaptations)
Occupational therapy (minor or
rehabilitation)
Occupational therapy (minor or
rehabilitation)
Podiatry (MSK only)
Podiatry (MSK only)
Treatment
Assessment
Treatment
Assessment
Fitting
Assessment
Fitting
Assessment
Fitting
Provide
Provide
Provide
Provide
Provide
Provide
Provide
Refer
Refer
Assessment
Provide
Treatment
Provide
Specialist
assessment
Specialist
treatment
Specialist
assessment
Specialist
treatment
Specialist
assessment
Specialist
treatment
Specialist
treatment
Assessment
Provide
Assessment
Refer
Procedure
Refer
Assessment
Refer
Procedure
Refer
Procedure
Provide
Procedure
Provide
Assessment
Refer
Treatment
Refer
Assessment
Provide
Treatment
Provide
Assessment
Treatment
Provide
Provide
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Refer
Refer
Refer
Refer
Refer
Refer
Refer
Phlebotomy
Procedure
Pathology - blood test
Procedure
Pathology - other test
Procedure
Exercise - as part of physical therapy for
MSK
Exercise on prescription
Patient materials to support treatment
Choice and booking of provider for
specialist care
Application of clinical thresholds
Application of surgical priorities policies
Booking and choice for patients
Dietetics and Weight Management
Dietetics and Weight Management
Provide
Order test and manage
according to result
Order test and manage
according to result
Treatment
Provide
Treatment
Other
Refer back to GP
Provide
Other
Provide
Other
Other
Other
Assessment
Treatment
Provide
Provide
Provide
Refer
Refer
All activities are for patients aged 16 years and
over
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