1. 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

2. 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”

3. AHSN coverage

4. 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.

5. 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

6. 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

7. 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

8. 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

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

10. 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.

11. 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.

12. 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

13. 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

15. 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

16. 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 Apr 3;9(1):42.

17. 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

18. 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