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National MSK Redesign . The facts. What do we know?. People in Scotland with MSK conditions currently experience….. Variable access to MSK services Variable management Variable measurement of outcomes And sometimes…long waits for these variable services ………………we could do so much better.

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Presentation Transcript
what do we know
What do we know?

People in Scotland with MSK conditions

currently experience…..

  • Variable access to MSK services
  • Variable management
  • Variable measurement of outcomes
  • And sometimes…long waits for these variable services

………………we could do so much better.

where has the need to change come from
Where has the need to change come from?

Delivery Framework for Adult Rehab, 2007 (SGHD)

  • Significantly redesign local MSK services
  • Management should be delivered by MDT teams in community settings
  • Health Works (2009)
  • NHS 24 - integral to the delivery of MSK Pathway and ‘Health Works’
  • Main point of direct access into rehab and MSK services
slide4
Why change? Areas of innovative practice exist around accessing AHP services but by no means equitable
  • Huge variance in access to services…..
  • Post code dependant.
  • Inconsistency in services offered and delivered
  • Regular and sudden changes to existing services
  • No self referral in areas
  • Having to arrange AHP appointment only after contacting
  • Poor access to advice and information
  • Inconsistent triage of patients
the scottish offer
The Scottish Offer
  • for any individual of working age who requires access to NHS healthcare services to address health barriers to work
  • include a definition of people’s functional capacity.
  • NHS needs to provide services support them back to work
the national msk redesign consists of
The national MSK redesign consists of
  • Focus on local services redesigning their MSK pathway around patients
  • Focus on employment, the ‘Scottish Offer’
  • Focus on developing a national point of access to local MSK services
  • Focus on developing interdisciplinary teams delivering MSK
what do boards need to do
What do Boards need to do?
  • Develop local referral hub
  • Develop interdisciplinary pathways
  • Embed outcomes measures into pathways
  • Ensure referral into mental health, employability and other acute services
  • Develop workforce
  • Education, training
slide8

Self management

  • Self mgmt advice
  • Community programmes
  • Web support – NHS inform
  • 12,000 clients

NHS 24 (up to 40,000 p.a)

SME + Absent >4 weeks

Any joint

Referrals made directly into hub from GP services and other hospital services i.e. A&E, orthopaedics

WHSS

1-2%

Approx 260-575

‘NHS Lanarkshire Referral Hub’

27,500 clients

Require MSK services

Phone Consultation

(1st appointment)

Direct appointments made at hub

Shoulder pathway

15%

3,575

Hand pathway

5%

1,375

Neck pathway

10%

2,750

Hip pathway

5%

1,375

Foot and ankle pathway

15%

3,575

Knee pathway

20%

5,500

LBP pathway

30%

8,250

  • All pathways will include ability to refer into the following services at any point in pathway even after first appointment / telephone consultation:
  • Pain Services– 8%, 1,100
  • Mental Health Support – including breathing space, case management, mental health teams – 10%, 1,375
  • Employability support – 10%, 1,375
  • Self management – including community leisure programmes and third sector programmes – 10%, 1,375
  • Rheumatology services – trigger questions agreed. – 1% 137

Patient Centred Pathway for MSK Services - example

where does nhs 24 come in
Where does NHS 24 come in?
  • It will run a national advice and triage telephone based

management resource for MSK conditions

Why?

    • Reduce inequity
    • Provide speedy access to advice and information
    • Consistent triage of callers
    • Appropriate referral onto local AHP MSK services
    • Realise efficiencies and release frontline capacity
what nhs 24 will do
What NHS 24 will do.
  • Work with Boards to ensure that those patients who need to be assessed by local AHP MSK services are referred directly to them
  • Need to be assured that Boards have redesigned their services to ensure these referrals will be responded to in a timely manner
  • Direct patients who need advice and information to high quality, validated information sources
programme aims
Programme aims
  • Non-emergency MSK Advice and Triage Service (In-hours, 9am – 8pm)

Introduce and sustain an NHSScotland MSK Triage

And Referral Management Service for patients with

MSK disorders.

  • Out of hours

Apply revised pathways for the existing people who

call NHS 24’s out of hours service with an

MSK condition.

a national msk advice and triage service for nhs scotland
A National MSK Advice and Triage Service for NHS Scotland
  • Run through NHS 24
  • Patients and referrers encouraged to use but not compulsory
  • Patients will phone a new specific number
slide13

NHSScotland MSK Advice and Triage Service – New non-emergency service

  • Aches & Pains Direct

Up to 300,000 referrals annually (240,000 adults)

WHSS referral for those

in paid employment & absent

from work for over 4 weeks

(Small-medium workplace)

30% self referrers

50% directed by GPs

20% directed from other sources

Protocol Driven

Advise & Refer Model

Ability to identify:

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

Enhanced self

management resources

Referred to local MSK hub for access into local services

New, Specific number

Ability to redirect

to medical services,

if safety issues arise

Triage and RM Model, LKH 27/3/11 vs.3

approach
Approach

Develop a system that is safe and sensitive enough to

identify and direct those who may potentially benefit from:

  • AHP intervention
  • Self management resources
  • Working Health Services Scotland
  • 999/Accident & Emergency referral
approach15
Approach
  • This is not a full physical assessment process
  • It is an advice and triage system
advice and information resources
Advice and Information Resources
  • Patients need information to support self management
  • Need for national resources that provide high quality, consistent information
  • NHS inform can fulfil that role:

Scottish Backs, neck, knee, shoulder sites, VideoPhysio, PhysioTools, Back in Control

slide17

2. NHS 24 MSK Model: Enhancement of

Existing Out-of-hours Service

85,000 routine MSK callers per annum

Existing algorithms enhanced to allow for identification of:

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

Estimate < 16,000

per annum

WHSS referral for those

in paid employment & absent

from work for over 4 weeks

(Small-medium workplace)

Enhanced self

management resources

Referred to local MSK hub for access into local services

08454 242424

Ability to utilise

current dispositions as required

Triage and RM Model, LKH 27/3/11 vs.3

out of hours emergency calls
Out of Hours Emergency Calls
  • Enhancements needed to existing system
  • Currently 85,000 callers with MSK conditions
  • Some of these would benefit from being directed to AHP services
  • No current option to do so
slide19

Scottish Backs

www.scottishbacks.co.uk

back in control
Back in Control

Back in Control

Welcome to Back in Control

Freely downloadable from (www.scottishbacks.co.uk) An evidence based patient information booklet about back pain.

slide21
VideoPhysio

www.youtube.com/videophysio

Falls, COPD, shoulder, knee &

neck pain videos coming soon.

slide22

MSK Newsletter

fferguson@nhs.net to sign up for it. Every 2nd month

slide23

….is a national service helping you to find amongst other information how to access public services and search for local information and advice.

  • Access to Scottish Backs and NHS inform via digital TV
  • Text NHS 24 to 61061
  • http://lookinglocal.gov.uk/digitv/cds/nhsscotland/Netgem/home.html
when will all this happen
Local Boards

Should redesign MSK services during 2011

NHS 24

Develop national Advice and Triage service during 2011

Enhance current out of hours protocols during 2011

Systems piloted in Lanarkshire and Lothian from autumn 2011

System evaluation – Spring 2012

Report consideration and national roll out

Resource pack and support

When will all this happen?