1. INTEGRATED MSK, PAIN & RHEUMATOLOGY SERVICE (IMPReS) COMMISSIONER AND PROVIDER JOINT WORKING

2. 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 … “

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Thank you for listening Any Questions?