1. Knowledge into Action Service redesign to improve the delivery of Musculoskeletal (MSK) services
Susan Shandley
Educational Projects Manager
NHS Education for Scotland (NES)

2. MSK Services Background and Context
12.25 million days are lost due to MSK disorders
In Scotland physiotherapists treat 271,000 MSK patients per annum
MSK conditions are a major cause of chronic disability and one of the commonest reasons for referral to secondary care.
69% (18,000) of people on orthopaedic waiting lists don't go on for surgery
Policy
18 week Referral to Treatment Standard ( S.G. 2008)
4 week Referral to Treatment Standard ( AHP National Delivery Plan, SG 2012 ) Also a developmental HEAT target 2013 to 2014
Quality Strategy ambitions
Redesign to improve delivery of MSK services
Self referral into AHP services
AHP led MSK delivery model

3. Evidence Search and Synthesis
Consensus Conference ( May 2010) to review evidence base for self referral
Reduced waiting times by cutting out GP referral delays
Improved patient access and satisfaction and quicker treatment
Lower levels of work absence
Cost efficiencies of up to £2 million compared to GP referral
Increasing self care and self management
Reducing complications with early intervention
Synthesis to support redesign of patient pathway
Centralise system of self referral into pathway via telephone triage (NHS 24)
Advice on self management
Electronic referral to local MSK clinic
Appropriate interventions delivered or sign posted by AHP team

4. Actionable knowledge Patients ( self management resources)
NHS inform - Musculoskeletal Zone
MSK phone app with links to employability services, and healthy working lives
Digital TV via NHS 24 digital TV Channel
Podcasts
Musculoskeletal advice and triage service NHS 24
AHPs
CD ROM - MSK Redesign National Guidance pack (also on web based platform)

5. Relational use of knowledge
MSK Community of Practice
National MSK Programme Board
National MSK sharing days
Twitter
Blogs

6. Building Organisational Capacity and Culture
In the redesigned MSK pathways AHPs are the initial point of contact for patients and therefore their roles require to be extended.
Critical success factor
Training to be undertaken to develop Advanced Practitioner (AP) skills for AHPs to enable delivery of redesigned MSK services
AHP Advanced Practice Education and Development Framework (NES)
Provides national guidance on the capabilities expected of AHPs working in AP roles within MSK services for each of the four pillars of practice
Clinical
Leadership
Facilitation of learning
Research and evaluation

7. Building Organisational Capacity and Culture
AHP Advanced Practice Education and Development Framework
Evidenced based
Pilot and wide consultation
Development Needs Analysis Tool
Direct to appropriate training and resources
Workshops in every NHS Board to implement the framework
Learning opportunities
485 AHPs benefited from NES funding
Completed evaluation report
Challenges with implementing learning into practice

8. Building Organisational Capacity and Culture

9. AHP Advanced Practice(Musculoskeletal) Website
Actionable knowledge
Education and Development Framework
Learning activities
Podcasts
Educational resources – formal education, general resources and reference materials
Relational use of knowledge
Sharing practice
Profession specific resources and links to forums
NHS Board MSK contacts

10. Building Organisational Capacity and Culture

11. Getting Knowledge into Action
The redesigned MSK service was implemented prior to the Knowledge into Action model however The process undertaken with MSK uses many elements of the change package and maps closely to some of the stages Pilot with future projects