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INTEGRATED MSK, PAIN & RHEUMATOLOGY SERVICE (IMPReS) COMMISSIONER AND PROVIDER JOINT WORKING
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Clinically led; Co-designed model of care
East Lancashire CCG working with Patients, Primary Care, GPs with Special Interest & Secondary Care Clinicians to develop the very best Integrated Musculoskeletal Service, that offers value for money, coordinated pathways of care and excellent patient experience Clinical Leadership – Appointment of a clinical lead to provide clinical direction and delivery of evidence-based care across the whole patient journey Care Closer to Home – 33% reduction in secondary care injections over 12 months Self management - programmes embedded into service delivery, facilitating independence and autonomy.; web site access for patient information and exercise videos Workforce –Valued expert multi-disciplinary team. Happy staff = happy patients - 99% of patients would recommend the service to family and friends Single point of Access – one entry point for all new referrals; 100% triage within 1 working day Driving up Primary Care skills and knowledge –training events delivered quarterly; advice line for GPs available daily Access – Secondary care waiting times for lower limb reduced to 1 week “Took time to listen properly and find a solution I was happy with … “
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Stakeholder discussions
“we want them to act as one team, even if they work in different locations or different organisations. As a team they understand and respect each other’s roles” “Its about the patient” Started with the commissioner case for change Once commenced the co-design process one of the first things commissioners did was to get some patient engagement This is what they told us – put the patient in the centre, work as one team
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Access for All The MSK contract was coming to an end and this was seen as an opportunity to improve the service, be more mindful of the patients that fall within the 9 protected characteristics, improve access for patients, promote self-care, become a more innovative service by implementing new ways of working which would future proof the service Musculoskeletal problems are significantly rising with the ageing population, increasing rates of obesity and low rates of physical activity Trauma and Orthopaedics is largest scheduled care spend for the CCG and was identified as an area for improvement by practices as part of the external review process for QOF QP Indicators. Increased waiting times for Physio and MSK Patients not being seen in the right place, first time and repeatedly being sent back to their GPs for additional referrals into other specialities Blackburn with Darwen and East Lancashire had different services, although they were provided by the same organisation
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Single Point of Access Triage (Senior clinicians)
New Model of Access Full spinal Drop In Patient G.P. IMPReS Single Point of Access Triage (Senior clinicians) Orthopaedics Pain MSK Rheum
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Intermediate specialist service Supported care / self care
Objectives Secondary care Intermediate specialist service Primary care Supported care / self care Change within hospital based activity Shift in provision of simple joint injections Shift to MDT models of care Improved conversion rates to T&O surgery Delivery of integrated specialist care closer to home: Community based single line managed MDT – inclusive of Rheumatology & Pain management Deliver of SPoA and same day triage Agreed integrated clinical pathways & protocols Up skilling primary care & relationship building Face to face communication with all localities Structured programme of educational forums Written communication pack incl re-branding Links with GP federations ‘MSK Beacon sites’ Autonomous independent patient Web site, for clinical management / information Delivery of self-management programme Shared decision making
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Holistic Support/ Self Management
Web site; for information and advice, including self-care leaflets and videos demonstrating simple exercise techniques for various con The service provides a holistic approach to the management of chronic pain conditions – Physical Health, Emotional Health, including personal Beliefs and Values Provides support for patients to manage their long term condition Shared decision making Venue privacy – inclusive group work Pain Management Programme (PMP) 3 Cohorts completed 9 patients per group Low drop out rate - 85% completed Excellent patient feed back “Very informative, ….pain levels reduced” Objective 1 outcome 1.1 and 1.2 Objective 2 outcome 2.2 “Life enhancing” “This course is a valuable resource to anyone suffering with chronic pain” Objective 1 - outcome 1.1 and 1.2 & Objective 2 outcome 2.2
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RELATIONSHIPS ARE KEY AND CHALLENGE IS HEALTHY
A joint approach with commissioners and service providers when utilising patient engagement and co-design takes time and organisation….an element of bravery is required. It is important to utilise ideas and also to balance idealism with realism What patients want is often what the service wants too…. The approach taken is now being fed into agreement of standard service redesign methodology for the Pennine Lancashire Transformation Programme Key points Commissioner case for change/assumptions – were not jointly owned No detailed examination of the current state – activity/resource Inclusion of contracting; finance and other colleagues at outset important Went straight from high level design to implementation – detail, detail, detail! Very rushed process due to ‘tender threat’ No joint detailed business case to determine shared impact and benefits Service KPI’s set after implementation underway rather than from the outset RELATIONSHIPS ARE KEY AND CHALLENGE IS HEALTHY
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Innovations / Future Plans
Spinal Drop-in Drop in clinic for rapid access to assessment, advice & treatment +/- diagnostics Stratified care approach Consultant –supported MDT Clinics Foot and Ankle MDT Clinic - for complex foot and ankle conditions Early Arthritis Clinic – “hot clinic” Future Plans Self referral and opt in appointments – increase choice of engagement for patients that don’t necessarily visit the GP. Review and amend EIA following service being operational for over 12 month Give due consideration for Transgender population Award Winning Service! Objective 1 outcome 1.1 and 1.2 objective 2 outcome 2.2 Objective 1 - outcome 1.1 and 1.2 & Objective 2 outcome 2.2
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Thank you for listening Any Questions?
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