Developing MSK Services in Southern Derbyshire Who am i? SDCCG: 56 local GP practices over 525,000 patients in southern Derbyshire. Liz Lawrence Senior Transformation Programme Manager for Planned Care 21/01/2016 SDCCG MSK services

Case for Change We needed to do something different. MSK services are complex and difficult. We know demand will increase. Provision across Southern Derbyshire was inequitable, disjointed with cumbersome pathways. Excessive waits for Orthotics Pockets of really good practice: independent physios, some community services, and good secondary care provision. Previous attempts of doing things differently had involved setting up community provision but secondary care were not involved- damaged relationships, no trust. MSK been focus for a long time, and there was a degree of change fatigue 21/01/2016 SDCCG MSK services

Our vision for MSK services We wanted to move towards a collaborative model where clinicians work together across primary care, community and secondary care to improve patient and clinician experience, remove waste from the system. Our vision for MSK services 21/01/2016 SDCCG MSK services

MSK – Proposed MSK Range of Services Community Access to Diagnostics Self-Management Primary Care Intermediate Care Specialist Intermediate Care GP Management Physiotherapy Secondary Care Self Help / Self-Management Primary Care / GP Management Specialist Physio / GPSI / Consultant Clinic Specialist Physio Orthotics Physiotherapy Self Help / Self-Management Secondary Care Orthotics Splinting Surgical Intervention Splinting Advice & Assessment Service Podiatry Podiatry Complex Orthotics Occupational Therapy Joint Injection Complex Joint Injection Joint Injection We talk about the Derbyshire wedge, where we look to push towards the left- so move care out of secondary care when it is not necessary, improving the ‘community offer’ & supporting patients to self manage. There needs to be support across the pathway of communication, access to timely advice and appropriate and timely diagnostics. All parts of the pathway need to link easily together with smooth transition for patients. ‘Core offer’ to be a priority to put in place in each locality Advice and Guidance Service 21/01/2016 SDCCG MSK services

Our approach We carried out a pilot GP triage of MSK services in July-October 14 working collaboratively with GPs and consultants. The results showed that up to 20% of referrals did not come into the hospital. All stakeholders were spoken to as individual organisations and then brought together at 2 stakeholder events. Building those relationships has been key. Really had to convince them why it was going to be different this time. From that, we have set up a pilot to test the concept of working in this way; key representatives from each organisation have come together to form an MSK Board with support of a wider MSK network. The MSK Board was formed in April 2015- this has GPs, independent, community and hospital physiotherapists, orthopaedic consultant, orthotics and imaging (& CCG). All representatives have the responsibility to feedback to their organisations. Governance structure set up to support. The wider network also includes pain services & rheumatology. 21/01/2016 SDCCG MSK services

Success so far…. We have also been able to tap in to other successes in the CCG. We have clinical improvement groups that consists are specialty groups with consultants and GPs. There is also a communication system set up called ‘Clinician Connect’ which makes it easier to access advice. New CCG website with easy access to guidelines & pathways as well as patient resources. There is already a great rheumatology service with easy access for GPs for advice and review Achievements: • Built up relationships between all stakeholders and improved confidence and challenged assumptions. • mapped what services are offered where including gaps in provision. • established baseline patient and clinician satisfaction with current services. • Work initially started work on Knee pathway to really understand the variation of what is delivered- have now published 3 interactive pathways for knee, hip and shoulder. These have buy in from local physios, consultants and GPs. Now improved with consistent advice and resources for patients and clinicians. Also use of shared decision aids. Secondary care & community teams can now direct primary care back to expected pathways and make it much easier to access advice. We are working towards wasted number of contacts for patients. • Have identified key linked physiotherapists in the community to access diagnostics and advice. • Developed training and competence standards and ongoing requirements for independent physios to access diagnostics. • Have a robust and timely advice service from secondary care open to GPs and key therapists.(Links also provided on pathways for ease) 21/01/2016 SDCCG MSK services

Frustrations…. We had lined up a patient represenative for the Board, but they have pulled out- looking at other ways to make sure patients are involved with the services. Struggling to get independent physios onto an N3 connection. (This will open up opportunities for them to use NHS eRS (old choose and book) they will be able to refer, accept referrals, access advice, give advice and be able to electronically request and receive imaging results. It will also help local GPs more aware of what services are available to them. Capacity- orthotic departments so overwhelmed and short staff that rolling out a robust education system and access to advice has been severely delayed. 21/01/2016 SDCCG MSK services

Next Steps… • Education of MSK work and pathways to all GPs. Also linking with local VTS scheme. • Education for refreshing GP skills on joint injections. (In the future will look at joint injection initiation training) • Possibly looking at joint injection competence standards. • Looking at training key therapists to deliver off the shelf orthotic devices. • Looking at how pain services can be integrated with MSK work. Longer term- ideally continue same approach- may look at outcomes based model and look at whether Board holds the budget for MSK services. 21/01/2016 SDCCG MSK services

Questions? 21/01/2016 SDCCG MSK services