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 MSK Strategy: Implementing NHS England’s Integrated MSK national specification 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
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
Kingston and Richmond MSK Integrated Service NHS Kingston and Richmond CCGs are working together to establish a Single Point of 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 Existing Triage Arrangements • 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. Phase 1 ( by April 2018) • 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 2 (by April 2019) • 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
Integrated MSK Single Point of Triage Pathway CLINICAL TRIAGE APPOINTMENT VIA BOOKING FUNCTION Access to self-management portal/ information Triage via Specialist Pain Physiotherapy for: Management Pain management Self Care Or as Rheumatology Rheumatology Follow Up appropriate Appts Orthopaedics Booked by Specialties Patient Community Orthopaedics Physiotherapy Diagnostic Requirements Community GP A&E Physiotherapy Joint Injections Using referral ESP protocols to direct patients into the most appropriate Referral clinic Utilising Standard Advice via referral Links to Kinesis form via e- referral/ Podiatry, Joint DXS Injections & Neurosurgery
Single Point of Triage 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 (SPT): Key Pillars 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 9
Progress to Date 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.
Next Steps/Timeline February 18 March 18 April 18 – October 18 Oct 18 – Mar 19 Apr 19 Mobilisation for Phase 2 Phase 2 go live! Finalise SPT service ERS front end trial SPT Go Live! specification & implementation Submission of Phase 2+ BCs period begins SPT Evaluation period begins processes established Deliver Pain training Finalise all ESP cross Review of existing pathways Deliver training and development of Rheumatology filter alternative pathways to training Establish MSK support Phase 2 of the work. Working Group as This will include: • ERS front end trial Steering Group Physiotherapy period begins • Pain management Establish evaluation • Begin HRCH/YHC ESP process Rheumatology cross training – • Orthopaedics includes shadowing Phase 2+ BC development Continue Physio continues Stakeholder discussions Review across LDU – around MSK diagnostics to inform Phase 2+ Continue Physio development Review across LDU – to inform Phase 2+ Continue SH development engagement Agree the outcomes data to be collected Stakeholder discussions around MSK diagnostics Ongoing links to SWL Collaborative MSK work programme
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