1. A New Musculoskeletal Pathway Vision or Reality ? Sarah L Mitchell, Rehabilitation Programme Manager, Scottish Government June Wylie, AHP Professional Officer, Scottish Government

2. Requirements for 18 week  The delivery of 18 weeks requires fundamental service transformation and re-design - doing the same faster will not achieve the 18 week target.  Access to services needs changing– planning strategy  Demand management for orthopaedic services in primary care is key to meeting access targets  AHP’s given opportunity to deliver on improving access and the necessary referral management process

3. Service Transformation  Service transformation will require not only the ability to influence processes, but to change mindsets, cultures, activities, and organisational power bases. Quote – Albert Einstein Insanity: doing the same thing over and over again and expecting different results.

4. Scale of MSK problem in UK More than one third of the population aged over 50 have pain at any site that interferes with their normal activities. More than 10 million adults (6 million women and 4 million men) consult their GP each year with arthritis and related conditions. This becomes more common with age with 1 in 10 people aged 15–24 seeking a GP consultation each year with a musculoskeletal problem rising to 1 in 3 people over 75 seeking a consultation.

5. Scale of problem 48% of work related problems in Scotland of MSK origin UK – 12.25 million work days lost due to MSK problems Costs £141 million just for GP consultations

6. Present model Pathway – GP onto orthopaedic waiting list. Many centres in Scotland patients screened by ESP’s within acute centres. National UK data identifies this pathway resulting in up to 70% not requiring surgical intervention. What does this mean for the patient? Sickness absence? Psychological problems? Reduction in functional capacity? No active management! Einstein!

7. Community Based Ortho Services  A Community Based Multi-professional Triage Team / Orthopaedic Assessment Service (OAS) – PT’s and GPwsi  A centralised referral management system – NHS 24 physiotherapy tele-health service?  All AHP musculoskeletal services to be delivered within a single system  All return clinic appointments following surgery seen by AHP MSK team

8. Community AHP MSK Services Integrated MSK Team Physiotherapy Podiatry OT Dietician Prosthetics Radiography Specialist nurse GPwsi Self Referral via NHS 24 Self management and advice (MKN, working backs etc) GP Referral Walk in Self Referral Electronic Referral Vocational Rehabilitation Services & Chronic Pain Services Orthopaedic waiting list Rheumatology services Other acute services Electronic Referral GP Referral Electronic Referral Vision or Reality ?

9. Evidence and the benefits to support this change in service delivery  Improved access to diagnosis and treatment  Reduced waiting times  Improved conversion rates to surgery in secondary care – up to 80% conversion.  Greater efficiency and productivity  Earlier return to work and avoidance of long term absence and long term dependency on benefits  Also support sshifting the balance of care and other Government policies (rehab framework, patient experience etc)  Promotes a self management culture for patients in Scotland

10. New Pathway Requirements  Self referral/primary care referral into MSK services  Community AHP led MSK model

11. The future of MSK pathways requires  The need to overcome professional barriers to explore more productive and effective options  Using lessons learnt and available evidence to design services  Support to fully explore greater productivity and efficiency in delivering MSK services

12. Critical Success factors  Professional support- Surgeons, GPs, AHPs  Agreement about need for a single system MSK service  Support to develop a pilot project with an NHS Board  A system of in-reach into acute hospitals to allow AHP staff to work with Orthopaedic Consultants in secondary care, while remaining primary care based  Identification of training and development needs to develop advanced practitioner skills.  Detailed evaluation plan and baseline data set to be developed before the start of the change so that the impact can be fully understood.  Identification of project resources