1. Orthotics Web Re Access
Nikki Munro
National Project Lead

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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

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

10. Website

13. 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