CATS casemix and pathways - FI holding page

CUMBRIA AND LANCASHIRE PCTS
INDEPENDENT SECTOR COMMISSIONING TEAM
COMMISSIONING OF CASEMIX AND PATHWAYS FOR INDEPENDENT
SECTOR CLINICAL ASSESSMENT, TREATMENT AND SUPPORT SERVICES
(CATS)
INTRODUCTION
April 2007
This paper contains detailed casemix and pathway information which has been developed
to support the commissioning of Clinical Assessment, Treatment and Support services
(CATS) in Cumbria and Lancashire as part of the Wave 2 Independent Sector (IS)
procurement.
The paper has been developed to support further local clinical discussions about the
development of CATS services. In line with the governance arrangements for IS
commissioning in Cumbria and Lancashire (see Annex 1) it assumes these discussions
will include PCT Professional Executive Committees and Practice Based Commissioning
groups in each PCT and secondary care clinicians in local hospitals. The paper will also
be presented to the Provider Reference Group which was established by the Independent
Sector Commissioning Board to ensure effective communication between PCTs, NHS
Trusts and IS providers.
Following the recent public consultation about CATS in Cumbria and Lancashire, the
proposals in this paper are consistent with the recommendations accepted by the joint
PCTs’ Independent Sector Commissioning Board to move forward with the
implementation of CATS services provided by the independent sector (IS).
BACKGROUND
1. Local Primary Care Trust representatives worked with the former Cumbria &
Lancashire Strategic Health Authority (SHA) in 2005 to develop the detailed
concept of CATS. CATS is based upon service models (e.g Tier 2 services) where
a redesign process led to improvements in demand management, reduced waiting
times and enhanced community-based services. In addition, CATS is intended to
respond to the national System Reform agenda which includes an emphasis on
patient choice, plurality of provision and contestability. For these reasons, CATS
was incorporated in a second wave of national procurements from the
independent sector announced in late 2005.
2. Following the development of a local specification for CATS services, the
Department of Health arranged a procurement process through which Netcare UK
has been appointed as a preferred bidder to provide CATS services in Cumbria
and Lancashire.
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Perot Systems
3. In parallel with the procurement process for CATS, the newly reorganised SHA
(NHS North West) commissioned Perot Systems in July 2006 as a strategic
consulting partner. Perot was asked to work with stakeholders in Cumbria and
Lancashire to involve clinicians, explore potential casemix and develop patient
flow pathways to support the integration of IS CATS services into the Cumbria
and Lancashire health community. This work was focused initially on three
specialty areas: general surgery, musculo-skeletal and ENT.
4. Perot systems involved a range of local primary care and secondary care
clinicians from across Cumbria and Lancashire in developing an understanding of
the CATS service model. Clinical representatives were also asked to help define
the services to be provided in CATS, whilst maintaining patient safety and
embedding best practice. On the whole, clinicians attending the workshops were
self-nominated. A full list of those attending the workshops is set out in Annex 2.
Further views on the outcomes of the workshops were obtained from specific
clinicians in subsequent one to one interviews.
5. The workshops took place over a two week period during September and October
2006 following a six week notice period to support clinical schedules. One
evening and one full day workshop was undertaken for each specialty. The
workshops identified provisional casemix and explored patient flow pathways
which were underpinned by clinical governance and ‘best practice’ principles as
defined by the local clinicians. It is appropriate to state that the workshop events
revealed varying levels of support for developing CATS services.
6. More than 70 local clinicians have contributed to defining the casemix and
pathways detailed in this document but it should be noted that no part of this work
is attributed to any particular individual.
Validation of Perot casemix and pathways
7. At the request of the PCTs’ Independent Sector Commissioning Team, Perot
Systems facilitated 2 further workshops in December 2006 and February 2007 to
which GP representatives from each PCT were invited. These were designed to
validate the casemix and pathway material produced by the larger clinical groups
in the main development process. The validation focused particularly on the
designation of certain clinical conditions as suitable for CATS whilst other
conditions could continue to be managed within primary care or referred to
secondary care. GP representatives were asked to review the material both as
clinicians and as commissioners.
8. Annex 3 therefore outlines a core range of high level pathways showing the entry
and exit points from CATS services. These pathways address the referral of
patients for a whole CATS episode (assessment, diagnostics, treatment planning
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and some treatments) as well as for the individual elements of CATS which will
be available to referrers as direct access services.
9. Annex 4 provides detailed casemix information encompassing ENT, General
Surgery and Musculo-skeletal services which can be included or excluded from
CATS.
CATS CONSULTATION
10. It was acknowledged throughout the recent period of public consultation about
CATS that further work was required to develop and agree robust clinical
pathways in each local health community. Therefore, in considering 15
recommendations presented following consultation, the joint PCTs’ Independent
Sector Commissioning Board agreed recommendation 4 as follows:
Work should continue at PCT level to determine appropriate and
safe clinical pathways for patients to enter and exit CATS services.
Pathways must support continuity of patient care including followup,
the transfer of accurate and timely information and effective
clinical relationships. This work should involve patient
representatives, primary and secondary care clinicians, colleagues
from social services departments and representatives of Netcare.
11. In the light of the preceding work on CATS casemix and pathways, the rest of this
paper contains proposals through which this recommendation can be achieved.
NEXT STEPS
12. To ensure the early and effective implementation of CATS services, each PCT’s
Professional Executive Committee is asked to receive and accept the high level
clinical pathways and proposed casemix for CATS in ENT, General Surgery and
Musculo-skeletal services.
These should be regarded as a consistent starting point across Cumbria and
Lancashire by which PCTs will commission IS CATS services from Netcare and
should therefore not be subject to major amendment or dilution prior to service
commencement. However, it is understood that the casemix information is in no
way a definitive listing and will therefore need regular review once CATS
services have become operational. In several places, the material already indicates
a need for further clinical discussion.
The pathways and casemix will, together, enable more detailed discussions in
each local health community with patient representatives, social care colleagues,
GPs, AHPs, secondary care consultants and Netcare representatives in line with
the recommendation made to the IS Commissioning Board. These discussions
need to confirm how the pathways will be underpinned by relevant clinical
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protocols or guidelines which will also need to be developed on a health
community basis.
It is understood that both the NHS in the North West and Netcare have purchased
access to the Map of Medicine (www.mapofmedicine.com) which is intended to
assist in the development of evidence-based clinical pathways. The IS
Commissioning Team will establish how the Map of Medicine can be used to
support discussions in each health community.
It is proposed that these discussions should be arranged in each area during May-
June 2007.
13. It is understood that there are well-established clinical relationships across
primary and secondary care in Cumbria and Lancashire and that in the past,
clinical guidelines and multi-disciplinary services have been developed. The
recent consultation process enabled a range of constructive clinical discussions to
take place in which the impact of introducing additional services provided by the
independent sector has been discussed.
To facilitate this ongoing dialogue, PCTs are asked to nominate a clinical lead(s)
who will co-ordinate further discussions between local clinicians and clinical
leads from Netcare and the Department of Health. NHS Trusts are also
encouraged to nominate clinical leads in the specialties where PCTs will be
commissioning IS CATS services.
PCT clinical leads should be linked to the local IS mobilisation teams established
in all PCT areas and will receive support if required from the Cumbria and
Lancashire IS Commissioning Team.
It is proposed that Clinical Leads are appointed during May 2007 and that
discussions with Netcare leads should begin immediately thereafter.
14. As a result of consultation, some PCTs have proposed additional specialties or
sub-specialties e.g. Dermatology, Audiology for inclusion in the CATS
procurement. A list of these as understood at the end of March 2007 is shown in
Annex 5. As the work commissioned from Perot Systems relates only to specific
specialty areas, the IS Commissioning Team needs to ensure a similar casemix
listing is developed for these additional specialties.
It is therefore proposed to request the nomination of clinical leads/PBC leads from
the PCTs concerned to define a similar casemix listing which could be
commissioned from CATS. This information would then be circulated to a wider
clinical audience, including secondary care clinicians for further development.
This work will need to be completed in the nominated specialties by the end of
June 2007.
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RECOMMENDATIONS
The PEC is asked to:
1. Receive and accept the proposed high level clinical pathways and casemix for
CATS services in ENT, General Surgery and Musculo-skeletal services shown in
Annexes 3 and 4.
2. Nominate one or more clinical leads who will facilitate further discussions
between local clinicians and clinical leads from Netcare and the Department of
Health, patient representatives and colleagues from partner agencies.
3. Nominate one or more clinical leads to contribute to a casemix listing in
additional specialty areas identified by the PCT as an outcome of consultation.
Andrew Bennett
Assistant Director of IS Commissioning
Cumbria and Lancashire PCTs
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Provider Reference Group
Chair: Ian Cumming
Frequency: Bi Monthly
Cumbria and Lancashire PCTs
Governance Structure – Independent Sector Commissioning
Updated April 2007
Local PCT Professional
Executive Committees
(Local Clinical Engagement
Group)
Chair: PEC Chair
Frequency: Monthly
Cumbria and Lancashire
PCT Boards
Cumbria and Lancashire
Independent Sector Commissioning Board
Chair: William Bingley (North Lancashire PCT)
Frequency: Monthly
Cumbria and Lancashire
Independent Sector
Contract Management Board
Chair: Director of Commissioning
Frequency: monthly
Local Health Community
Mobilisation meetings
Chair: Local Director / Lead
Frequency: TBC
ANNEX 1
Cumbria and Lancashire
Wave 2 CATSs and
Electives Mobilisation
Group
Chair: Andrew Bennett
Frequency: Fortnightly
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Cumbria and Lancashire PCTs
Independent Sector Commissioning Board
Current Membership
Current Nominations- Executive Current Nominations- Non Executive
PCT
Blackpool David Bonson Director of Commissioning
BWD Janet Ledward Director of Commissioning Ibrahim Master Non Executive Director
Central Lancashire Doreen Hounslea Director of Commissioning Ian Cherry
Cumbria Alan Horne Chief Operating Officer Maggie Chadwick Chair
Non Executive Director
East Lancashire David Peat Chief Executive Mary Thomas Non Executive Director
North Lancashire Kevin Parkinson Director of Finance William Bingley Chair
Ex officio chair Contract
Management Board Meeting
Cath Galaska Director of Commissioning
PEC Chair x 1 Dr Amanda Doyle Medical Director/PEC Chair
PEC Chair x 2 Dr Terry O’Connor PEC Chair
LMC Representative Dr Robin Jackson Dr S Hardwick
Lead Chief Executive- Ian Cumming
In attendance:
Head of IS Commissioning Team, Chair
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Participants in Perot development process (September/October 2006)
Musculoskeletal
ANNEX 2
Name Position Organisation
Nigel Courtman Consultant Orthopaedic Surgeon Furness General Hospital
Pamela Calder Senior Manager Morecambe Bay NHS
Trust
Linda Gillespie Extended Scope Practitioner North Lancashire PCT
Martyn Lucking Doctor in Medical Orthopaedics North Lancashire PCT
Amanda Ball MSK Physiotherapy Lead North Lancashire PCT
Louise
Thompson
Nurse Practitioner, Orthopaedics BHA
Steve Parr
Burman
GPwSI in Orthopaedic
Medicine/MSK
NLPCT & Blackpool PCT
Cecilia Kemp Extended Scope Practitioner in MSK NLPCT
Cliff Elley GP Lancashire & Morecambe
GP
Commissioning Group
Fayyaz
Chaudhri
Maryport GP N Cumbria
Edward
Thompson
Podiatry Manager Morecambe Bay NHS
Trust
Susanna Roberts Superintendent Physiotherapist UHMB (University
Hospital
Morecambe Bay)
Andrew
Rotheray
GP Ambleside Commissioning
Executive
Stephen Huck GP Kirkby Stephen & Eden
Valley
Cumbria
David Ward Divisional Manager Blackpool, Fylde and
Wyre Hospitals
Daniel Redfern Clinical Director & Consultant,
Orthopaedics
Lancashire Teaching
Hospital Trust
Arshad Javed Consultant Orthopaedic Surgeon Blackpool, Fylde and
Wyre Hospitals
Stewart Radiology Directorate Manager Blackpool, Fylde and
Whiteley
Wyre Hospitals
Angela White Clinical Director orthopaedics UHMB (University
Hospital
Morecambe Bay)
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Fiona
McDougall
UHMB (University
Hospital
Morecambe Bay)
Gillian Au GP Poulton le Fylde Wyre
PCT
Iain Lowrie Clinical Director orthopaedics East Lancs Hospital Trust
John Halsey Consultant Rheumatologist UHMB (University
Hospital
Morecambe Bay)
Julia Westaway Commissioning Manager Morecambe Bay PCT
Marie Bowler Asst Director Blackpool, Fylde and
Wyre Hospitals
Pauline Wilson Clinical Services Manager Morecambe Bay PCT
Claire Hughes Chronic Pain Nurse Specialist Morecambe Bay NHS
Trust
Abdul Lalkhen Pain Fellow Morecambe Bay NHS
Trust
Judy Leigh Physiotherapist WGH
Tim Weighman GPwSI, MSK BWD PCT
Trish Sloane Physiotherapist MBHA
Suzanne Vallis Physiotherapist Morecambe Bay NHS
Marwam
Bukhari
Consultant Rheumatologist
Trust
UHMB
Nigel Roberts Podiatrist East Lancashire PCT
Clare Hale Physiotherapist WGH, Morecambe Bay
NHS Trust
Andrew Severn Consultant, Pain Management Morecambe Bay Trust
Rao Chandini Consultant Rheumatologist Blackpool, Fylde and
Wyre Hospitals
Stephen Jones Consultant Rheumatologist Blackpool, Fylde and
Wyre Hospitals
Lesley Walters Head of Physiotherapy Lancashire Teaching
Hospital Trust
Mr D Redfern Consultant Orthopaedic Surgeon Lancashire Teaching
Mr George
McClauchlan
Hospital Trust
Consultant Orthopaedic Surgeon Lancashire Teaching
Hospital Trust
Mr I Guisasola Consultant Orthopaedic Surgeon Blackpool, Fylde and
Wyre Hospitals
Gail Ferrier Clinical Director Orthopaedics North Cumbria Acute
Dr Stephen
Jones
Trust
Consultant Rheumatologist Blackpool, Fylde and
Wyre Hospitals
9

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Dr Wendy
Dodds
ENT
Consultant Rheumatologist UHMB
Name Position Organisation
Phil Stoney ENT Consultant UHMB
Jeremy Marriott GP Lancaster & Morecambe
PBC Consortium
Martin Atherton GP Fylde PCT & Park Road
Surgery
Alan MacDonald GPwSI Eden Valley PCT
Nick Murrant ENT Consultant North Cumbria Acute Trust
John de Carpentier ENT Consultant RPH
Will Aucott ENT Consultant BVH
M Timms ENT Consultant East Lancs Trust
Dinesh Patel GP Preston PCT
Archana Garg GP Preston PCT
Marianne Rintoul Commissioning Manager E & L PCTs
Andrew Keith ENT Consultant Blackpool Victoria Hospital
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General Surgery
Name
Mark Lambert
Position
General Surgeon
Organisation
Blackpool Victoria Hospital
Peter Smith GP Blackpool PCT
Jo Grove GP, Maryport
Robin Jackson GP Lancaster & Morecambe
PBC Consortium
Jonathan Heath General Surgeon Blackpool Victoria Hospital
Andrew Evans General Surgeon ELHT
Sarah Ghani GP Central Lancashire PCT
Gaynor Arnold Senior Physiotherapist RLI
Julie Hunter Senior Physiotherapist Furness General Hospital /
Morecambe Bay Hospital Trust
Jeremy Ward Consultant Surgeon Lancashire Teaching Hospitals
Trust
Kishore Pursnani Consultant Surgeon Lancashire Teaching Hospitals
Trust
Richard Kelsall GP Leyland, S Lancs
Alistair MacKenzie GP Kendal
Mujahid Khurshid Consultant Surgeon Blackpool Victoria Hospital
Stewart Whitley Radiology Directorate Manager Blackpool Victoria Hospital
Ravi Srinivasan Consultant Surgeon Blackpool Victoria Hospital
Graham Riding Consultant Surgeon Blackpool Victoria Hospital
Simon Raimes Consultant Surgeon North Cumbria Acute Trust
John Abraham Consultant Surgeon UHMB
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High Level Clinical Pathways for CATS – Cumbria and Lancashire
ANNEX 3
This Annex contains 7 flow diagrams which outline the high level clinical pathways
available to patients and GPs. These include access to full CATS episodes and to the
separate elements of CATS (diagnostics, treatments, therapies) which will also be
available. For completeness, the final diagram shows the conventional referral to a
hospital outpatients department.
Pathway 1: CATS assessment with/without diagnostics
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Pathway 2: CATS assessment leading to a procedure or therapy service
Pathway 3: Direct access diagnostics, therapy or treatment from CATS
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Pathway 4: Full CATS episode including work-up for surgery and onward referral to
secondary care
Pathway 5: CATS episode leading to unexpected clinical finding/critical event
needing onward referral to secondary care
14

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Pathway 6: CATS episode with unexpected clinical result not requiring onward
referral to secondary care
Pathway 7: Direct referral to secondary care based on patient choice or clinical
presentation
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Proposed ENT Casemix for referral to CATS Service
ANNEX 4
The table below provides detailed information on the range of ENT conditions considered
suitable and unsuitable for referral to CATS. This information was developed in multidisciplinary
clinical workshops and validated subsequently by PCT GP representatives.
ENT casemix for CATS service
Primary Care
Practitioner
Simple otitis media – with
no concerns about hearing
Otitis externa resolving <
1 month
Ear wax, intact tympanic
membrane
Suitable for CATS
service (

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Primary Care
Practitioner
management
Suitable for CATS
service (4 per annum)
according to current guidelines
requiring surgery
Severe acute infections - e.g.
parotitis, mastoiditis
Acute lumps with obvious Non suspicious head and Suspicious neck lumps e.g. ?cancer
cause
neck lumps with
undefined diagnosis
requiring investigation
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Children < 3 years
Suspected Cancers
*ENT emergencies
Simple Bell’s palsy Atypical facial palsy not secondary
to stroke* requiring surgical
intervention
* These are clinically urgent and will require direct referral to secondary care
ENT referral criteria into CATS service
Referral criteria ENT cases requiring further assessment/ investigation to
confirm diagnosis
ENT exclusion Criteria from CATS service
Exclusion criteria Children

Draft v1
ENT direct access diagnostics in CATS
service
Note: Protocols/guideline for CT and MRI need
to be defined
ENT therapy services in CATS service
ENT minor procedures in CATS service
MRI
Sleep studies
Sialograms
Balance investigations
Caloric testing
Echo cochleography
Skin prick allergy testing
Plain film x-rays
Audiology – not hearing aid service (note
direct access to this may already be available
in secondary care setting)
Ultrasound
Barium Swallow
Laryngoscopy
CT
MRI
Speech and Language Therapists
Dysphonic patients
Paediatrics SLT should be available
Swallowing assessments
Physiotherapy
Required for Vestibular Rehab
Hearing therapist
Audiology (interface to PMS required to
obtain demographic data transfer)
limited if no sedation
Suction microscopy
Aural toilet
Nasal sinus endoscopy
Cautery
Laryngoscopy
Epleys manoeuvre
Removal of foreign body
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Proposed General Surgery Casemix for referral to CATS Service
The table below provides detailed information on the range of General Surgery
conditions considered suitable and unsuitable for referral to CATS. This information was
developed in multi-disciplinary clinical workshops and validated subsequently by PCT
GP representatives.
Primary Care
Practitioner
Lumps and bumps – GP
confident about diagnosis
Suitable for CATS service
(

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Primary Care
Practitioner
Pre-op work up as an
enhanced service by
Primary Care (potential
PBC development)
Dyspepsia – excluding
DOH to capture diagnostic
reporting work nationally
Suitable for CATS service
(

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Primary Care
Practitioner
Suitable for CATS service
(

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General Surgery assumptions underpinning identified casemix
General Surgery assumptions • Skills to level of PwSI
• Netcare will work with local clinicians to ensure local
standards, requirements are met
• Protocols for General Surgery will be developed in
conjunction with Secondary Care specialists
• Netcare will provide training for all clinical staff
• GP’s and Hospitals will be able to use Choose and
book
General Surgery diagnostic investigations in
CATS service
General Surgery direct access diagnostics in
CATS service
General Surgery therapy services in CATS
service
General Surgery minor procedures
Ultrasounds – e.g. abdominal, scrotal, vascular,
Doppler
Plain X rays
Scoping/’Oscopies’
FNA
CT Scans- CT colon
MRI Scans
IVP
Barium Enema and sigmoidoscopy
Barium follow through / swallow
Diagnostic endoscopic procedures
Ultrasounds – e.g. abdominal, scrotal, vascular,
Doppler
Plain X rays
Scoping/’Oscopies’
FNA
CT Scans- CT colon
MRI Scans
IVP
Barium Enema and sigmoidoscopy
Dietetics
Not for basic dietary advice. To support general
surgical clinical finding and to provide specific
relevant advice i.e .recommending specific diet
to manage bowel related issues
limited if no sedation
Wound care
Removal of lumps/bump non ca
Removal of skin tags
Surgical debridement if not requiring GA
Pinchografts
FNA
Injections of varicous veins/ avulsions or short
length veins under local anaesthetic
Flexi-sigmoidoscopy
Other scopes if sedation available
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Proposed Musculo-skeletal Casemix for referral to CATS Service
The table below provides detailed information on the range of Musculo-skeletal
conditions considered suitable and unsuitable for referral to CATS. This information was
developed in multi-disciplinary clinical workshops and validated subsequently by PCT
GP representatives.
Primary Care
Practitioner
Upper limb
General upper limb
problems e.g.
shoulder (adhesive
capsulitis), tennis
and golfers elbow
Carpal tunnel
syndrome not
indicated for surgery
Lower limb
Knee problems with
no concern
Straightforward OA
knee and hip pre-op
workup then referred
direct to secondary
care for surgery
(scoring system for
GPs use needs
development)
Suitable for CATS service
(

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Primary Care
Practitioner
Achilles
tendonopathy and
plantar fasciitis
Simple back pain
and neck pain with
or with/without
radicular symptoms,
no concerns
General
Musculoskeletal
pain with no red
flags able to be
managed in primary
care
Polymyalgia
rheumatica
Suitable for CATS services
(

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Primary Care
Practitioner
Children with simple
presentations
Ganglions not
requiring removal
Post menopausal,
‘simple’
osteoporosis
Suspected new
inflammatory
arthritis responding
to medical
management lasting
less than a 6 weeks
duration
Suitable for CATS services
(30)
Acute fractures
Severe trauma
Patients who require reassessment
following surgery by the surgeon who
operated on them
Suspected osteomyelitis
Metabolic bone disease
Acute mono arthritis including septic
arthritis
Acute paediatric joint pain
Musculoskeletal referral criteria for CATS service
Referral criteria Functional level decreasing
Pain level rising
Diagnostic uncertainty
Un-resolving acute cases
Joint injections (excluding joint injection for inflammatory
arthritis) or time limited treatment unavailable at GP Surgery
Nerve conduction studies required
Musculoskeletal exclusion criteria from CATS service
Exclusion criteria Suspected musculoskeletal tumour – refer to secondary care –
two week rule
Chronic conditions already diagnosed – exacerbations not of
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time limited duration of 6 weeks in total
Inflammatory arthritis – refer to rheumatology
Urgent/serious conditions – e.g. septic – cauda equina syndrome
refer to secondary care
Cases where diagnosis obvious and referral is for discussion on
surgery under protocol with secondary care
Patients with chronic conditions that cannot be managed within
primary care
Patients returning post CATS service with ongoing problems
(as detailed in secondary care casemix)
Musculoskeletal assumptions underpinning identified casemix
Musculoskeletal assumptions GPs may feel comfortable doing some injections and
uncomfortable doing others- need to assume clinicians in
CATS service proficient and experienced in giving all main
injections.
Transport needs for patients will be considered.
GPs may if required refer the patient somewhere other than
CATS service
Back pain service in CATS service will work on a biopsycho-social
model, and have a function and symptom focus-
Psychological support will be available for pain sufferers
A universal scoring system will be developed for OA hips and
knees
PCT commissioners and PBC groups to monitor direct access
to investigations and contract position
Focus groups will be set up to define protocols and guidelines
Netcare will provide training for clinicians
A multidisciplinary service provision model will be provided
in CATS service
Musculo skeletal diagnostic investigations in
CATS service
Musculo skeletal direct access diagnostics in
CATS service
Bloods
Basic Pathology and Microbiology
X-rays (plain film)
Simple Ultrasounds
Gait analysis
Nerve conduction studies
Dexa scans
MRI
CT
Nuclear Medicine- bone scans
Neurophysiology
X-rays (plain film)
Simple Ultrasounds
Ultrasounds
Shoulder - Suspected rotator cuff injuries
Hands - lumps
Feet – suspected Morton’s neuroma
27

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Musculo skeletal therapy services in CATS
service
Musculo skeletal minor procedures in
CATS service
Areas to be further defined
Gait analysis
Nerve conduction studies
Peripheral joint MRI
Physiotherapy
OT
Podiatry Orthotics and Surgical Appliances
depends on guidance from DOH needs further
work up
Joint injections (under U/S guidance) excluding
inflammatory arthritis
Joint aspiration for diagnostic purposes IV and
subcutaneous injections
Aspiration biopsies
Ganglion aspirations
Caudal epidurals under X-ray adhere to BSR
guidelines
Facet joint injections under X-ray guidance
(This needs to be checked with the pain
society recommendations and resulting
service contract. IS provider did not
propose to do epidurals in CATS service as
they feel it is unsafe due to lack of
anaesthetic support in case of
complications)
Soft tissue injections (e.g. tennis elbow)
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Cumbria and Lancashire PCTs
Specialties requiring additional capacity from CATS – position at 21 st March
PCT
Specialties requiring
additional capacity
Blackburn with Darwen Musculo Skeletal, General
Surgery, Dermatology,
Neurology
Blackpool Musculo Skeletal, General
Surgery, ENT,
Dermatology, Neurology
Specialties not required
ENT, Rheumatology,
Urology, Gynaecology
Rheumatology, Urology,
Gynaecology
Central Lancashire Musculo Skeletal, General
Surgery, ENT,
Gynaecology
Rheumatology, Urology
East Lancashire Musculo Skeletal, General ENT, Rheumatology,
Surgery
Urology, Gynaecology
North Lancashire Musculo Skeletal, General Rheumatology, ENT,
Surgery, Neurology,
Audiology
Gynaecology, Urology
Cumbria To be determined To be determined
Annex 5
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