Joint effects 2011 - An update of the involvement - 18 Weeks

Joint effects 2011
There is much greater standardisation of assessment and referral forms across
many health boards and more patient information provided although the extent and
content varies.
There has been a lot of pathway and redesign development, which continues as
part of the current National MSK Redesign Programme.
The regular use of systems and technology to support patient care still remains
highly variable. Some services have, and make good use of, legacy systems. Others
have built their own databases to support quality improvements but there are still
many services that are dependent on paper for the retrieval of patient outcomes.
Many but not all have access to e-GP referrals and some specialised services are using
e-vetting very successfully.
The lack of systems and diary management can only hamper flexible and adaptable
service development, however some services have effectively used off-the-shelf
products as an interim measure.
Advanced AHP practice in partnership with other clinicians forms the basis for many
services. Most services are delivered within community settings, health centres and
community hospitals. Ensuring advanced practice is integrated into normal services
and not seen a ‘stand-alone’ is clearly a current development in some boards. The
use of injection therapy is now widespread throughout physiotherapy and podiatry in
Scotland and in some places available within every service.
Increasing links to exercise and better integration of work, health and leisure are
evident; some boards lead the way in this. Staff skill mix has been adjusted to include
exercise and fitness professionals within the traditional healthcare team. There are also
examples of exercise classes being targeted at particular populations and links with
the voluntary sector to deliver patient-led group activity.
In the hospital sector the use of education classes in preparation for planned joint
replacement surgery is becoming widespread.
Conclusion
Scotland has led the world in permitting and promoting self referral to AHP services,
this approach now underpins Scottish Government Policy, but many AHP services are
still quite difficult to find on the internet. How patients and the public learn about self
referral is also difficult to judge. The NHS 24 pilot may assist with this.
AHPs are in a unique position to support and promote Scottish policies on working
health, and assist as many people to stay at work, or return to work as soon as
possible. More needs to be done to establish links with leisure services and to be
effective advocates for physical activity and public health.
Services will have to demonstrate they are not only effective and efficient but that
they add value. The national approach to consistent outcome measurement will
support this.
There continues to be variation in the delivery and management of musculoskeletal
services between and within individual health boards in Scotland. This is also
confirmed by The Arthritis and Musculoskeletal Alliance (ARMA)’s Musculoskeletal
Map of Scotland due for publication later this year.
It will be important that the good practice identified in this report and the
opportunities offered by the National MSK Redesign Programme are used
to reduce variation and continue to drive improvements in the quality of
musculoskeletal services for the people of Scotland.
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