Clinical Lead Update - MSK Jim Hampton Thursday 30 March 2017 - - PowerPoint PPT Presentation

Clinical Lead Update - MSK

Jim Hampton

Thursday 30 March 2017

Overview of the aims for MSK services

• To develop community based MSK services

with a single point of access

• To include orthopaedics, pain management

and rheumatology

• Multi-disciplinary, one-stop clinics
• Patient seen in the right place at the right time
• Focus on supporting patients to self manage
• Will help to manage the growing demand for

MSK services with an ageing population

MSK Community Service Model

(Training) PRIMARY CARE GP

Service to provide pathways, Patient involvement

Patient Discharge d

Secondary Care Choice of hospital

• ffered to patient via

C&B Rheumatology Pain clinic Specialist radiology TRIAGE Clinician ESP Community Service One stop – diagnosis, treatment, specialist physiotherapy, podiatry assessment, injection clinics ESP GPwSI Podiatry ENP Consultants - Rheumatology Sport/MSK Medicine Radiologist Pain clinic Joint injections Diagnostics Full admin, IT support OUTCOMES

S P A

Further work up + diagnostics

Community Podiatry Physiotherapy Red flags Systemic disease

Social care Psychology Exercise for health

Follow-up Rheumatology Education CPD Clinical Governance

Previously……..

• Developed the Hip and Knee programme and

evaluated the outcomes in 2015

• Carried out a Needs Assessment for hip and

knee replacements in 2016, to inform the future commissioning requirements for BaNES

Overview of Needs Assessment

• Needs Assessment completed to ensure H&K

arthroplasty meets the needs of the population.

• Increasing elderly population will lead to a

£1M+ increase in costs – unaffordable.

• Good overall arthroplasty outcomes but could

be further improved e.g. extend physiotherapy

• Highlighted the need to simplify the referral

pathway as there were many different routes of referral.

Hip & Knee programme - Outcome Data

• National and regional benchmarking data consistently

identified BaNES as an outlier for hip and knee replacement surgery rates

• 40% of patients who attend the programme go on to self-

manage rather than have surgery

• 47% are directly referred for surgery
• Approximately 14% of patients who complete the

programme and decide to self-manage, subsequently present for surgery within a year

• The length of stay for those who go on to have surgery,
• n average spend 1.5 bed days less than those not

attending the programme

Update on 2016/17 MSK Plans (1)

Orthopaedics:

• Reported on the outcomes of a Needs Assessment for

Hip and Knee replacements to GPs and local secondary care clinicians

• Introduced the use of RSS for all orthopaedic referrals

except ‘red flags’ and 2ww

• Patients referred to the RSS in the first instance and

then referred on to the OIS, Hip & Knee programme or secondary care as appropriate

• Increased the capacity of the Hip & Knee programme

Update on 2016/17 MSK Plans (2)

• Developed a Patient Information Leaflet for the Hip & Knee

Programme

• Reviewed and revised several MSK commissioning policies

including patellar resurfacing and direct access to MRIs Pain Management:

• Established an interim Community Pain service to support

GPs with managing patients who do not meet the RUH revised referral criteria

• Developed a Back Pain and Sciatica pathway with local

providers and commissioners, which is now being implemented through a recently convened local implementation group

Total savings to the CCG

CCG Total Savings Hip Knee Total 2014/15 (Oct – Mar) £233,680 £399,546 £633,226 2015/16 £268,732 £599,319 £868,051 2016/17 (Apr – Jan) £186,944 £695,506 £882,450 £2,383,727

Savings as part of QIPP, in each of the periods

CCG Total QIPP Savings Hip Knee Total 2014/15 (Oct – Mar) £233,680 £399,546 £633,226 2015/16 £134,366 £325,556 £459,922 2016/17 (Apr – Jan) £40,894 £281,162 £322,056 £1,415,204

Next steps:

• Develop a comprehensive community pain

management service during 2017/18

• To scope the potential to develop community based

Rheumatology services e.g. patient initiated follow up appointments, support for patients to self-manage

• Develop proposals for community MSK hubs
• To extend the Referral Support Service to include

Rheumatology in 2017