1. Introduction This toolkit has been put together in an attempt to provide colleagues with a set of documents, tools, links and information to support the review and delivery of an Integrated MSK Pathway which has been under development by colleagues across South Central from October 2009. Planned Care Team, NHS South Central 1/8/11 MSK Pathway Toolkit

3. Creatively building a great MSK Pathway Background On 8 th October 2009, NHS South Central SHA organised a day for all clinical and non clinical staff to come together and look at what a future MSK service could look like. The types of people at the meeting were:- GPs, Physiotherapists, T&O nursing staff, consultants in orthopaedics, rheumatology, radiologist & pain management, patient representation, acute and primary care managers. The first part of the day was spent encouraging everyone in the room to think creatively about what a future MSK service might look like. Each small group created their own vision for the future, what it should feel like for the people going through the pathway and how it should feel for those who work within the service. The output from this session was to create a gallery of ideas and from this, common themes were pulled together. During the following 18 month work has continued to define, develop and implement the pathway at a local level ensuring particular attention is made the agreed principles:- Sickness prevention & health promotion emphasised at each point of contact by all health professionals. Use of informed decision making with patients at each point of the pathway. Patient agreed outcome measures at each stage.

4. ICATS (Integrated Clinical Assessment and Treatment Service) Specialist Capability: GP Therapist Surgeon Rheumatologist Pain Psychology/CBT Diagnostics Dietetics MDT learning Prevention & Education Promote Self-Management Patient Choice On Decision To Consult Telephone advice line – Self management Non NHS Specialist 3 rd Sector Patient Support Groups Advice & Guidance Patient Agreed Outcomes Measured Along Pathway Informed Decision Making at each point in the pathway Locally Determined Venue A&E STarT Back Questionnaire On Line Telephone In person GP Physio – Direct access Surgery ERP Principles Hip and knee School Discharge planning 48 Hours 48 hours to 14 days 18 weeks South Central MSK Pathway GW/RW 23.11.2010

5. The pathway was developed by clinical and managerial colleagues across SC drawing on best practice, experience and emerging thinking. The contents are set out specifically in an order that is considered most logical and beneficial, and a number of the aspects have been developed, tested and then refined in light of use. The contents also include information on Falls & Fragility Fractures, although not part of the pathway the information has been included for consideration if required. Colleagues are urged to undertake an in-depth review of their current service before embarking on plans for significant changes or the commissioning of new services. The various contents of the toolkit have been utilised or are in place in different locations across SC. Under the contents list are identified those PCTs/named clinical colleagues who can provide further information due to application in that area.

6. Contents- MSK Pathway Principles, Overview and Evidence- Folder 1 High level introduction to the pathway and the principles underpinning it. The case for ICATS- a literature review of the evidence for an ICAT service. Pathway and Service Review Tools- Folder 2 FIRE Companion Guide- a service review toolkit. Developed and refined to undertake a deep dive review of an interface service NHS Institute toolkit for delivering interface MSK services. CATS Checklist produced by the 18 weeks team. MSK pathway re-design from Oldham PCT Interim evaluation of ICAT service from Oxfordshire PCT Service Specification Examples- Folder 3 Examples of service specification from across South Central & elsewhere in the UK Pathway and Referral Examples- Folder 4 A mix of examples of pathway specific conditions- hip, knee, back etc. Example of referral processes from Oxfordshire PCT Financial Modelling and Programme Budgeting Information- Folder 5 Information shared from Pennine MSK and Oldham PCT. STarTBack- Folder 6 Presentation of supporting evidence Information detailing roll out and a major trial Evidence for sub-grouping patients Training and support package Copy of the actual tools Informed Decision Making and Decision Aids- Folder 7 Presentations making the case for adoption of shared decision making and use of aids. Specific aids information and link Fall & Fragility Fractures