Orthotics Web Re Access Nikki Munro National Project Lead

MSK Drivers AHP MSK referrals 400,000+per annum 100M MSK consultations in UK per annum 10 million work days lost MSK issues 2nd largest group in receipt of incapacity benefits (22%) NHS Scotland Variation in information, access, waiting times, investigations ordered, data collection and measurement of impact What are the drivers

MSK Ambition PATIENT TO RIGHT INFORMATION OR PERSON FIRST TIME Data Target 4 Week Waiting Time Target ACCESS EARLY INTERVENTION AND PREVENTION CLEAR PATHWAYS AND ESCALATION EFFICIENT PROCESSES IMPROVEMENT DRIVEN BY DATA-4 WEEK TARGET/DATA TARGET What was my project

Specific ideas to test or change concepts Musculoskeletal Driver Diagram -Getting patients onto the right pathway, first time. Primary Drivers Secondary Drivers Specific ideas to test or change concepts Consistent high standard self- management advice Development self-management video’s/advice MSK Health Improvement Strategy Public Marketing Communication Web Orthotic Review AIM To get patients with an MSK problem to the right advice and/or right healthcare professional first time. If they require assessment or intervention they are seen within 4 weeks (March 2016 target) Technology Enabled Care NHS24 MATS and Clinical Telephone Consultation Web based algorithms MSK Solutions Tool AHP MSK Standards Whole System Workflow Clinical protocols Clinical pathways Imaging protocols Exit routes –specialist services , third sector, leisure trusts MSK Orthopaedic Rehab Whole System Sustainable Clinical Pathways/Flow Embed evidenced based person centred pathways Shift flow to appropriate professions/part of pathway Exit/Parallel routes Integrated hubs Electronic outcome measures Opt in as standard Reminder systems Process Infrastructure MSK Administration Hubs Electronic tracking and data systems Top right box See context of other work ongoing Optimal booking and capacity utilisation Meet ISD 4 week data requirements Monitoring and evaluating flow-duplication → test of change Monitoring and evaluating re-referrals Outcome measures Adapting systems Evolving MSK Leads Group Using data/ improvement methodology to drive change Developing Improvement and Analytics Capacity MMI Using data to inform care delivery improvements Senga Cree – April 2015

AHP MSK Redesign To get patients with an MSK problem to the right advice and/or right healthcare professional first time. Technology Enabled Care Risk Stratification -Telephone and Web Access and Assessment High Standard Self-Management Advice MSK Solutions- evidenced based education Sustainable end to end clinical pathways Whole system working Fewer referrals to orthopaedics Consistent standards of care and consistent outcomes Process Infrastructure MSK Admin Hubs and electronic tracking systems Optimal booking and capacity utilisation Data and data analytics to drive improvement Using Technology is a priority so fits well with the type of project suggested for this course

Key Outcomes Data driving Improvement National Data Collection ISD – First Publication 15th Dec 2015 Physiotherapy, Orthotics, Podiatry, OT Demand, waiting times, Source of Referral, Body part, DNA NHS Scotland 100% self referral AHP MSK NHS24-single point of telephone contact self referral 15% callers to self management 9 HB now on –most recent Forth Valley &Borders Physiotherapy added to NHS MATS App, NHS Inform-consistent self management information Admin Hubs Health Boards-Admin Hubs every board-DNA’s 6%, fill rates improved 94%, reduction orthopaedic referral. Consistent pathways and care- MSK AHP Standards Shift Orthopaedics to Physiotherapy MSK Solutions Tool Web based access algorithms Push towards self referral for patients for all MSK

Going Forward – MSK Web Based Access Active living –cueerntly ongoing work to create patient self assessment algoritms

Orthotics bid details Develop Orthotics reaccess via Active Living Website For existing orthotics patients Populate with self management resources Each board can choose to opt in Case Study Orthotics Reaccess via active living website Issues patients currently need to be re referred into orthotic services Developing the underpinning work needed to deliver an Orthotics section on the Active Living website. Developing the algorithms for an On-line self referral tool which would stream patients and produce SCI Gateway referrals for the following: New referrals Re-Access Repairs Or Redirect patients to other resources or services. Developing resources to support self management which includes leaflets.   At the end of the project each board will, if they choose, have the ability to enable a board specific version based on postcode enabling patients to access the various elements of the Orthotic service. Patients will be able to access: Direct Self referral. Direct Re-access. Direct repairs (potentially Assistant / Technician led). Self management videos. Videos showing what the patient can expect from the service. Links to other resources. This patient-centred approach should smooth the patient journey and reduce the number of GP orthopaedic or other health care practitioner appointments which are currently being used to enable patients to the access the Orthotic service. Access to the repairs, self management resources and redirection algorithms should reduce the number patients arriving for an appointment with an Orthotist immediately, building the capacity to reduce waits. This along with the implementation of evidence based care previously supported and delivered on time will make a real contribution to achieving the 4 week target for Orthotic services across Scotland Leadership

Progress so Far National Consultation event Gathered views from variety of sources Algorithm has been built and tested on a small scale

Website

Next Steps Need to finalise details Go out for testing in one board (admin) Further testing in other boards (admin) Testing with patients Referrals generated via sci gateway