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

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Joint effects 2011 The National Musculoskeletal Redesign Programme 2010 – 2013: Allied Health Professional involvement The need for redesign was signalled within the Delivery framework for adult rehabilitation published in 2007. The framework identified that considerable improvements could be made for patients in both their outcome and experience of Scotland’s MSK services. In particular by: ●● improving access to services ●● providing consistent and high quality information about their condition as early as possible ●● providing information and advice to support self-management ●● shortening waiting times ●● adopting evidence-based treatment plans ●● enabling people to stay in or return to work ●● ensuring an equal, high quality of care across Scotland ●● achieving sustainability and efficiencies to reinvest in better MSK services. There are three key work areas: 1 Multi-professional MSK care pathways 2 A pilot using NHS 24 telephony to provide a National Advice and Triage Service to signpost to information and local MSK services. 3 Embedding Working Health Services Scotland in all MSK pathways Multi-professional MSK care pathways AHPs within health boards across Scotland are working as part of multidisciplinary teams, developing and introducing a range of MSK care pathways. This MSK scoping exercise demonstrates a lot of ‘pathway activity’. More is planned. Business redesign approaches are being used to modernise services and ensure patients have access to high quality, consistent information about their condition as soon as possible. Pathfinder Boards have focused on pathways that are based around the highest patient activity, i.e. low back pain, hip and knee problems. They have adopted a multidisciplinary approach and take a ‘patient-eye view’ of the existing service on offer, asking the question “why” at each step of the patient journey. The aim is to reduce duplication and take steps out, so people can access the most appropriate healthcare option quickly, easily and safely. There are many more AHPs practicing in new ways, e.g. referring patients for, and acting on, diagnostic tests, prescribing medication and undertaking injections avoiding the need for another GP referral. The MSK pathway programme is being supported by dedicated project management support with training for new roles and advanced practice provided through NHS Education for Scotland (NES). The National Advice and Triage Service NHS 24 is leading on the development of the national point of access to MSK services using their established telephony platform. The NHS 24 pilot will go live in two early adopter sites between December and January. The project will be evaluated and is due to report in early Summer 2012. The service will operate Monday to Friday, 9.00 am to 8.00 pm. Patients and those wanting access to advice and information will be encouraged to call a national number. The first person a caller will talk to will be a call operator. They will be taken through a series of questions about their MSK problem, covering demographic details, key safety and problem-specific questions, risk indicators and employment. Call operators follow protocols developed by MSK experts, have extensive training and clinical supervision on hand at all times. The protocol has been developed and endorsed by a national expert panel including service users and is based on the NHS 24 operating model where patient safety 8 mskscoping2011-rs.indd 8 03/11/2011 11:01
Joint effects 2011 comes first. It also includes the STarT MSK screening tool under development at Current referral pathway Keele University. This assists in identifying people at low, medium or high risk of experiencing persistent problems. It is anticipated that by using this approach, NHS 24 will be able to manage a proportion of callers on behalf of local AHP services, free up much needed frontline 18 (0) days 20 (2) days 68 (50) days capacity and avoid many GP appointments. Low-risk callers Advice and information resources available on the web, via digital TV and even through a smart phone application. Encouraged to call the NHS 24 service back after two weeks if their symptoms don’t improve. Medium or high-risk callers Will be referred directly to local MSK services as well as being provided with advice and information resources. Callers with work-related issues Working Health Services and local employability services, where appropriate. Patient visits GP 1.8 times GP completes on average written or Referral before being electronic received referred to referral by local AHP service or patient AHP service, self-refers put onto waiting list Proposed referral pathway 5 days Patient contacted and offered an appointment 78 (60) days Patient attends GPs will be encouraged to direct their patients to the new MSK line but will still Less than 40 days be able to refer directly into local services if they feel the new phone service is not appropriate for some patients. Callers will have quick and easy access to high quality advice and information about how to manage their condition from Day 1 and direct referral if needed into local MSK services. This contrasts sharply with current practice. Currently, patients may need to visit a GP on more than one occasion before being referred to a local MSK service and then face a long wait (can be around nine weeks in many services) before receiving advice or the required treatment. Patient calls NATs, is triaged and referral sent on to local MSK service Patient contacted and offered an appointment Patient attends 9 mskscoping2011-rs.indd 9 03/11/2011 11:01
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Page 17 and 18: Patient involvement Access: evening
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Page 27 and 28: Joint effects 2011 Rheumatology pod
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Page 37 and 38: Joint effects 2011 Low Back Pain Ph
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Page 47 and 48: Joint effects 2011 Glossary ACL Ant

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