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REFORMING MSK PATHWAYS

REFORMING MSK PATHWAYS. The Commissioning Cycle. Needs Assessment. National picture reflected locally: JSNA Increasing demand for consultant outpatient appointments Inappropriate GP referrals to Orthopaedics and Rheumatology Lack of standard primary care pathways

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REFORMING MSK PATHWAYS

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  1. REFORMING MSK PATHWAYS

  2. The Commissioning Cycle

  3. Needs Assessment • National picture reflected locally: • JSNA • Increasing demand for consultant outpatient appointments • Inappropriate GP referrals to Orthopaedics and Rheumatology • Lack of standard primary care pathways • Long waits for community physiotherapy

  4. Outpatients, Elective IP/DC Specialist Physiotherapy CATS Incl GPwSIs / ESPs / Consultant input Physiotherapy / Podiatry / Exercise Referrals (Patient able to self-refer) GP Practice Improve standard of care, knowledge and patient information SoTW MSK Vision Secondary Care based Agreed protocols for referral pathways Community based Patient Access

  5. What works – evidence? • Nice • Literature search • Local Intelligence gathering • Conferences • Visits

  6. Community Physiotherapy

  7. Service development and pathway reform

  8. What works – evidence? • Nice • Literature search • Local Intelligence gathering • Conferences • Visits

  9. Methodology – NETS • Current state – 13 week waiting times • Future state – 4 days

  10. Community Physiotherapy – service specification

  11. Issues and challenges • Self referral • Shroud waving • Professional vested interest • No evidence?

  12. Market stimulation & Procurement • Relationships • Procurement law • Whole system effect • Procurement process - award contract 2 providers • Time – lines • Managing expectations

  13. Implementation • Time • Mosaic approach • Resilience • Mount Doom

  14. Contract Management and Evaluation • Service specification • How frequently • How long • Managing Risk

  15. Tier 1Average Waiting Times in Hours

  16. TIER 2Initial Assessment Average Waiting Times

  17. TIER 2Review Average Waiting Times

  18. Conclusions Long process Issues and challenges Unexpected outcomes Remember the evidence Cost of hairdressers

  19. Thank you Questions?

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