Kingston & Richmond Transformation Integrated Musculoskeletal - - PowerPoint PPT Presentation

Kingston & Richmond Transformation Integrated Musculoskeletal Model and Pathways Right Care, Right Place, Right Time

Governing Body March 2018

peoGopleathe right care, in the right place at the right time

 SWL Clinical Senate and Senior Management Team have committed to the development of an integrated MSK service across SWL.  This includes every area jointly developing:  Common specification and governance for all Single Point of Triage(SPT)  Integrated pain pathway including active links to mental health  Integrated rheumatology pathway and MDT in each SPT  Integrated orthopaedic pathway  Standardised referral documentation and protocols  Single patient outcome and quality measures which will allow us to proactively manage the SPTs  A single self-management resource across SWL  Developing alternative care pathways and services

SWL MSK Strategy: Implementing NHS England’s Integrated MSK national specification

Benefits

 More people accessing the right care, in the right place at the right time  Improved patient experience and outcomes  Providers working together to deliver standardised care pathways  Improved referral management via Electronic Referral System  All routine GP MSK referrals managed by the Single Point of Triage(SPT)  Improved equity of access and reduce variation  More appropriate utilisation of diagnostic capacity

South West London MSK

 MSK conditions account for up to 30% of GP consultations nationally (DH, 2016)  MSK referrals make up approximately 10% of all GP referrals (NHSE, 2017)  The SPT ensures people are seen in the right place, by the right person, first time.  Registered population of Kingston 210,000 and Richmond 215,000  Referral information for 2016/17 Kingston/Richmond GP’s  Orthopaedics KCCG 2, 900, RCCG 2,700  Pain Management KCCG 800, RCCG 700  Rheumatology KCCG 850, RCCG 950  Physiotherapy/ESP KCCG 7,000, RCCG 10,000  MSK MRI Diagnostics KCCG 1,700, RCCG 4,500

NHS Kingston and Richmond CCGs are working together to establish a Single Point

• f Triage (SPT) and the appropriate range of alternative pathways.

This has included partnership working and co-design of service models and approach between:  Kingston Hospital NHS Foundation Trust  Hounslow & Richmond Community Healthcare NHS Trust  Your Healthcare  Chelsea and Westminster Trust  GPs – Karina Knights, Andrea Davis, Naz Jivani  Kingston and Richmond CCGs The introduction of the Single Point of Triage, is the first stage in this journey.

Kingston and Richmond MSK Integrated Service

Kingston and Richmond MSK Integrated Service

• A single point of triage does not currently exists for all MSK conditions.
• KCCG have commissioned KHFT to provide a robust ESP triage and assessment for orthopedics

as well as a treatment service.

• RCCG have commissioned HRCH to provide ESPs triage this manages circa 30% of all physio

and orthopedic referrals. HRCH also provides a treatment service. Existing Triage Arrangements

• Establish a more integrated Single Point of Triage (SPT) for orthopedics, pain, rheumatology and

physiotherapy which will:

• Review referrals
• Refer to the most appropriate service
• Provide advice and guidance from ESPs
• To optimise the use of advice & guidance for general practice via Kinesis
• To optimise the use of DXS to reduce variation in referrals

Phase 1 ( by April 2018)

• Development of pathways for rheumatology, Pain and orthopedics across primary, community and

secondary care

• Direct Listing, supported by guidelines with pre and post-operative work up and rehabilitation,

utilising the principles of enhanced recovery and utilising local information on co-morbidity factors to ensure patients are fit for surgery

• An emphasis on improving public health outcomes and supporting preventative measures

Phase 2 (by April 2019)

Patient

Self Care

CLINICAL TRIAGE

Triage via Specialist Physiotherapy for: Pain management Rheumatology Orthopaedics Community Physiotherapy Diagnostic Requirements Joint Injections

Using referral protocols to direct patients into the most appropriate clinic

APPOINTMENT VIA BOOKING FUNCTION

Pain Management

Integrated MSK Single Point of Triage Pathway

Referral Utilising Standard referral form via e- referral/ DXS

Rheumatology Orthopaedics

Access to self-management portal/ information

Community Physiotherapy

Advice via Kinesis Follow Up Appts Booked by Specialties GP A&E

ESP

Links to Podiatry, Joint Injections & Neurosurgery

Or as appropriate

The aims and objectives of the SPT are to: Ensure MSK patients from Kingston and Richmond CCGs are seen by the right person, in the right place first time Provide a patient focused service, enhancing patient choice and the patient experience Standardise appropriate GP referral pathways whilst appropriately managing demand in primary care Reduce the number of inappropriate referrals into secondary care Develop a service that dovetails with and compliments existing local services Promote self-management with information and advice given at the point of access and reinforced throughout the pathway

Single Point of Triage

 Delivery by a team of MSK Extended Scope Practitioner(ESP) and Physiotherapists  Triage of all routine GP referrals within 48 hours (Red flags and 2week wait (cancer) separate urgent pathway)  Liaison with other components of the MSK service to ensure a seamless pathway ensuring the patient sees the right person, at the right time  An emphasis on appropriate self-management and shared decision making to empower people and prevent the unnecessary use of unscheduled care – supported by a SWL Collaborative aim to introduce a patient self- management portal  Reductions in clinically avoidable MRIs, as patients will be triaged and MSK MRIs will be requested where deemed appropriate (in line with the Royal College of Radiologists guidelines)  Supported by a robust clinical governance processes

Single Point of Triage (SPT): Key Pillars

9

Well established Kingston and Richmond MSK Working Group, chaired by GP Programme includes managers and clinicians from from HRCH, KHFT, ChelWest(West Middx), Your Healthcare Redesign of single point of access pathway is underway including use of e-referral Routes from SPT to Radiology SPT specification drafted and is being reviewed Routes for advice and guidance via Kinesis (GP to Consultant e- communications system) under review Clinical governance protocols for the SPT providers has been developed is being finalised.

Progress to Date

February 18 March 18 April 18 – October 18 Oct 18 – Mar 19 Finalise SPT service specification Deliver Pain training Deliver Rheumatology filter training ERS front end trial period begins Begin HRCH/YHC ESP cross training – includes shadowing Continue Physio Review across LDU – to inform Phase 2+ development Continue SH engagement ERS front end trial & implementation period begins Finalise all ESP cross training Establish MSK Working Group as Steering Group Establish evaluation process Phase 2+ BC development continues Continue Physio Review across LDU – to inform Phase 2+ development Agree the outcomes data to be collected Stakeholder discussions around MSK diagnostics SPT Go Live! SPT Evaluation period begins Review of existing pathways and development of alternative pathways to support Phase 2 of the work. This will include:

• Physiotherapy
• Pain management
• Rheumatology
• Orthopaedics

Stakeholder discussions around MSK diagnostics Ongoing links to SWL Collaborative MSK work programme

Next Steps/Timeline

Mobilisation for Phase 2 Submission of Phase 2+ BCs processes established Apr 19 Phase 2 go live!