Role of Academic Health Science Networks in Supporting Improved Care for MSK Rhian Hughes Theme Director, Person Centred Care, West Midlands AHSN Co-Director, Institute of Primary Care and Health Sciences, Keele University

AHSNs were established “……. to support the spread of innovation across the NHS in England” “……. to align clinical research, informatics, training, education and healthcare delivery in their respective regions, with the twin objectives of improving healthcare and generating wealth”

AHSN coverage

Core Objectives of AHSNs: Focus on the needs of patients and local populations. Build a culture of partnership and collaboration. Speed up adoption of innovation into practice to improve clinical outcomes and patient experience. Create wealth.

Vision for Person Centred Care Right care: meeting needs and preferences, right place, right time, with compassion and respect Holistic: physical, mental, social, emotional Shared care: preference sensitive, informed, agreed between person / carer and professional Safe: benefits and risks inform options and modes of care delivery Co-created: with public / patient input and feedback Quality Improvement: PCC should drive quality

STarT Back - Stratified Care for low back pain Prognostic Screening Matched pathways + Back pain is common – of those consulting in primary care 85% will have non specific low back pain Of those consulting in primary care 55% are at low risk of poor outcome – modifiable prognostic factors Factors such as fear, anxiety, mood motivation, work situation should be assessed and have an impact on outcome STarT Back utilising a screening tool that includes physical and psychosocial to give a score Low risk Medium risk High Referral to psychologically informed physiotherapy Referral to standardised physiotherapy Minimal treatment of advice & medication Complexity

STarT Back Headlines Improved Clinical outcome for patients at 4 and 12 months Improved patient satisfaction Credible and acceptable to patients Much less time off work Stratified care was cheaper, saving: an average £34 per individual (health costs) an average £675 per individual (societal costs) Proof of principle RCT

Key cost savings (STarT Back/IMPaCT Back) GP consultations Visits to NHS consultants Investigations MRI/x-rays Epidural injections Other private healthcare Medication Return to work Whitehurst et al 2012 Arthritis Rheum

Change in local Physiotherapy referral patterns Low risk Much less referral Medium risk More referrals early High risk patients Shorter waiting times for physiotherapy

Delivery Model learning from exemplars PCC Network of Champions Regional ‘Communities of Practice’ clinical, commissioning, managerial, academic, IT National networks Change management expertise PCC Toolkit of resources (web based) Tools embedded in NHS systems, DVD training materials, business case, audit PPI Groups (link to PILAR) - Patient resources E-information, interactive telehealth, new apps Events and communications: PCC workshops, training, webinars, blogs, twitter Network events will enable sharing of best practice, national speakers, new best practice projects to be shared.

Community of Practice Workshops Barriers Patients expect active investigation/treatment Ease of use – tool/referral pathways Uncertainty about: best management/services available/Physiotherapy access and waiting times Lack of feedback from Physio Enablers Contextualise the proposal - e.g. reducing outpatient referrals  Patient power - patient stories, videos, high quality patient information Innovation – easy access to tool, auto calculation, auto referral? Patient information Resource – champions, support for training/masterclasses, feedback loop Credibility – clinical/managerial champions, research plus ‘real life’ data. Impact - Feedback loop, positive outcomes Enablers: Contextualise – in real NHS issues – quipp/pressures waiting list etc Use patient power Innovate Resources – champions, QI, masterclasses Credibility – high quality research not challenge but use real life data, experience with other GPs etc.

Innovation Referral to Physiotherapy generated automatically GP Consultation Referral to Physiotherapy generated automatically Appropriate Physiotherapy treatment Good quality patient information System developed with GPs Training for physios provided

Innovation Template fires with back pain read codes Red flag screening question first 9 Item tool Auto-calculates score Treatment recommendations ‘pop up’ Bespoke printable patient information Designed with patients with back pain Contains key messages Physiotherapy referral automatically generated for those with medium or high risk score Physiotherapists received training in psychosocial factors Innovation Template fires with back pain read codes Red flag screening question first 9 Item tool Auto-calculates score Treatment recommendations ‘pop up’ Bespoke printable patient information Designed with patients with back pain Contains key messages Physiotherapy referral automatically generated for those with medium or high risk score Physiotherapists received training in psychosocial factors

http://www.keele.ac.uk/sbst/

Impact/Evaluation Audit across Care Pathways Improved physiotherapy waiting times / % of patients seen with target wait time 100% patient satisfaction Enhanced care pathways Improved discharge letters back to GP (90% vs 26%) Reduced referrals to secondary care Reduced subsequent GP consultations Trained >170 musculoskeletal physiotherapists in matched treatments in WM Integrated screening tool in General Practice systems and negotiation of clinical pathways 6 Clusters in North, Central and South High quality patient information Audit tools/evaluation/Business Plans – e toolkit Industry collaboration – EMIS/patient.info Public Health England – MECC for Low Back Pain National uptake – RCGP /NB Medical GP Update/BMJ e-learning

Pilot, adoption and spread Model OA Consultation Patient presenting with joint pain 45 years and over GP makes, gives, explains diagnosis, analgesia, promotes self-management, gives guidebook, refers to nurse Practice Nurse supports self-management; guidebook; goal setting, exercise, weight loss, pain control Pilot, adoption and spread Porcheret M, Main C, Croft P, McKinley R, Hassell A, Dziedzic K. Development of a behaviour change intervention: a case study on the practical application of theory. Implement Sci. 2014 Apr 3;9(1):42.

New Resource JIGSAW-E ORGANIZATION NAME Tony Davis, Rhian Hughes CI; Professor Krysia Dziedzic PI WM-AHSN, UK Professor Sita Bierma-Zeinstra Department of General Practice Department of Orthopedics University Medical Centre Rotterdam, Erasmus MC (EMC) Professor Thea Vilet Vlieland Leiden University Medical Center (LUMC), The Netherlands Richard Stone Medilink Professor Kåre Birger Hagen/ Dr Nina Østerås Diakonhjemmet Hospital (DH), Oslo, Norway Professor Ewa M Roos/ Dr Søren Skou University of Southern Denmark (DK) Professor Sandra Pais/ Dr Clara Cordeiro University of Algarve, Portugal (UA) New Resource

Key Messages AHSNs – regional assets that support delivery of the NHS Five Year Forward View, the recommendations of the Francis Report, the Government’s Accelerated Access Review and the Carter Review The WMAHSN does so by promoting the spread and adoption of beneficial innovation through its networks, services and opportunities process Collectively, AHSNs offer a means to spread innovation further