The National Musculoskeletal (MSK) NHS Lanarkshire PilotScottish ‘Health’ Offer – National Forum26th January 2012

Dr. Sarah L MitchellNational Programme Manager Delivery Framework for Adult Rehabilitation

2 MSK NHSL PILOT

04/19/23

1 in 4 GP consultations MSK related (1 in 3 for over 75’s)

More than 10 million GP consultations (MSK) each year costing £141M (UK).

30,000 patients sitting on Orthopaedic waiting list in Scotland, with conversion to surgery as low as 11%.

7.6 million working days lost due to MSK related conditions.

40,000+ MSK referrals into Lanarkshire AHP Services.

WHY ARE WE RE-DESIGNING OUR MSK SERVICES?

Patient Experiences Variation in…

Access…Management...Outcomes…Waiting Times

3 MSK NHSL PILOT

04/19/23

WHAT ARE WE PROPOSING?……..what does that mean for each of us?

A National MSK Triage and Referral Management Service for NHS Scotland utilising the technologies of NHS 24

Local referral management hubs within boards

Direct referral into WHSS for those working in SME’s

Development of Interdisciplinary pathways using evidence based outcome measures

Development of algorithms within pathway to ensure correct service provision

Early identification of employability issues, anxiety depression scores

Greater utilisation of leisure facilities

Increased or Decreased workload for some of us.

Better use of clinical skills and resources.

Better patient clinical outcomes. Right Patient, right place, right time.

Some of us may have to grow our current skill set.

We all need to place high value on clinical evidence and patient outcomes.

We all need to be prepared to be held to account more as leaders.

4 MSK NHSL PILOT

04/19/23

Referral pathwayCurrent referral pathway…

Proposed referral pathway…

* National Advice & Triage Service

5 MSK NHSL PILOT

04/19/23

NHS SCOTLAND MSK ADVICE AND TRIAGE SERVICENon- Emergency

self referrers

GP directed

directed from other sources

Protocol Driven

TRIAGE TOOL

Ability to identify:

non-emergency (non 999, A&E) callers with sprains, strains and pains of joints and

muscles

MEDIUM / HIGH RISK

Referred to local MSK hub for access into local services, plus

www.nhsinform.co.uk/msk

0845 604 0001

Ability to redirect to medical services, if safety issues

Ability to redirect to medical services, if safety issues

WHS REFERRAL

for those in paid employment & absent from work for over 4 weeks (Small-medium org)

WHS REFERRAL

for those in paid employment & absent from work for over 4 weeks (Small-medium org)

Triage Tool•Developed by expert panel•Safe: identifies red flags•Employment: identifies WHS•Includes STaRT MSK tool: stratifies into low, medium and high riskHill et al www.thelancet.com 29/09/11

Triage Tool•Developed by expert panel•Safe: identifies red flags•Employment: identifies WHS•Includes STaRT MSK tool: stratifies into low, medium and high riskHill et al www.thelancet.com 29/09/11

LOW RISK

Enhanced self management resources, web, digital TV & APP

www.nhsinform.co.uk/msk

LOW RISK

Enhanced self management resources, web, digital TV & APP

www.nhsinform.co.uk/msk

6 MSK NHSL PILOT

04/19/23

MSK SERVICE REDESIGN – New Process

First ContactAHP telephone consultation and EQ5D

HUBFirst Contact

Physio assessment(EQ5D and outcome

measures)

First ContactPodiatry

assessment(EQ5D and outcome

measures)

First ContactOT assessment

(EQ5D and outcome

measures)

Self Management and exit from

systemEmployability Services

TRAK – automated

letter sent to patient (and communicati

on sent to CRMS)

TRAK / CESInfo. dump

A&E

Leisure

Older People

Services

Mental Health

Vocational Services

Rheumatology

Community Pharmacy

Pain Services

Dietics

Ortho

2nd AHP Appointment (intervention)

7 GE Title or job number

04/19/23

Key Performance Indicators

• Total MSK demand• Patient DNA rates• Patient referrals to

Secondary care (Ortho surgery)

• Patient waiting times

• GP consultations• Investigations• Prescription

charges

• Patient referrals into Leisure services

• Patient referrals into Employability services

• Mental Health referrals

• Patient experience• Functional

Improvement Outcomes- If we want to find what's best for the people of Scotland we need to measure!!

Monitoring Data – NHSL (Pre-pilot)

9 MSK NHSL PILOT

04/19/23

Patient Experience (Pre-pilot)

AGE Total No

%

0-15 years 3 1

16-29 years 48 15

30-44 years 55 17.5

45-59 years 103 33

60-74 years 80 25

Over 75 years 26 8

Employment Status Total No

%

Employed Full Time 89 28

Employed Part Time 40 13

Self Employed 7 2

Student 33 10.5

Homemaker 5 2

Carer 8 2.5

Unemployed 30 9.5

UnemployedwithIll Health

14 4

Retired 89 28

• 315 data entries to date were gathered from NHS (19%) and Community Links (81%)

• 21% of these supplying a postcode which falls into the top 15% of deprived areas in Scotland as indicated by the SIMD 2009.

• 28% Post and 72% street questionnaires.).

• 97% of participants stated that their ethnic background was white.

• top three most commonly cited MSK problems are currently identified as back (39.3%), Knee (25.2%) and shoulder (21.3%).

• 86% of people indicating that they had an MSK related problem, attended their GP

• 22.8% of patients who attended GP appointment waited 3-4 weeks and 22.8% waited more than 12 weeks for MSK appointment.

• 90% of individuals indicated that they did not receive any help from other non NHS services

• 24% of people were aware of the PAL service which operated and of those that were aware of the help line and had used it, 32.5% found it very useful and 23.4% found it quite useful.

• 94% indicated that they had followed some or all of the advice given to them during treatment.

• 83% of people felt that they were given enough information on how best to manage their conditions

• 86% of patients unemployed at the time of their problem stated that they had no discussions with NHS staff on the benefits of employment for their health.

• 42% of patients in employment felt that treatment received had made a big difference in helping them stay at/or return to work more quickly.

• 64% of employed patients recorded that they were absent from work because of their muscle or joint problem. The most common period of sickness was cited as being between 1 and 2 weeks.

• Over 77% of people reported that their health had improved moderately or significantly as a result of MSK care services.

• 79% of individuals were likely to recommend services received to friends and family.

• 63% of participants that received NHS treatment for their MSK problem stated that they would either be quite or very likely to use a new interactive service linked to self management.

• 28% of individuals stated that they had received information from NHS staff on other support services. Again GP’s were cited as the most common source of information.

Highlights

10 MSK NHSL PILOT

04/19/23

NHSL PHYSIOTHERAPYNew Attendances / New DNA / New DNA %Time: 01/04/2010 – 31/3/2011Split: Locality

11 MSK NHSL PILOT

04/19/23

NHSL PHYSIOTHERAPYReturn Attendances / Return DNA / Return DNA %Time: 01/04/2010 – 31/3/2011Split: Locality

12 MSK NHSL PILOT

04/19/23

NHS Lanarkshire – Lower Back Pain (LBP) Analysis

Straight to Leisure

13 MSK NHSL PILOT

04/19/23

LEISURE REFERRALS12 months projection

Projecting over 700 additional

Leisure referrals in first 12 months

14 MSK NHSL PILOT

04/19/23

NHS Lanarkshire – Physio Waits Current>Projected

Target

Pysio Weeks Wait Data Input

Last Friday of Month

Pysio # Patients Waiting Data Input

Last Friday of Month

15 MSK NHSL PILOT

04/19/23

NHS Lanarkshire - Orthopaedic Demand2010 vs 25% Reduction

- Over 3000 Ortho Patient Demand Reduction

Equally Well Process

18 MSK NHSL PILOT

04/19/23

MAJOR DELIVERABLES

Equitable access for MSK patients to appropriate management options

Consistent, high quality information and advice

Information developed and adopted across NHS Scotland

Enhanced user experience

True health/employability pathway

Wider Cost Benefits – Full economic analysis