Quality Account
2014-15
Community MSK (NHS) Services
Contents
Introduction
3
Part 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
4
6
7
7
8
8
8
9
9
10
Chief Executives Statement
Medical Directors Statement
Statement of Assurance
Further Information & Feedback
Quality Assurance & Quality Management
Regulatory Compliance
CQC Inspection & Compliance
HSCIC Compliance (IGSoC)
Contribution to National Audit Databases
Clinical Governance at Connect
Part 2 - Key Successes & Achievements
2.1
Innovating the MSK Pathway (Newcastle West Pilot)
- Improved appointment waiting times
- Improved GP/Onward Referrals
- Improved patient Experience
- Improved GP Support
- Reduced patient waiting times & direct access to surgery
- Direct Access to Surgery
- Improved Clinical Outcomes
- Effective Partnership Working & Commissioner Experiences
2.2
Award winning Services
2.3
New MSK Commissioning Model
2.4
Community MSK Service Development
2.5
Results of Clinical Audits
- Patent Safety Audits
- Evidence of Clinical Effectiveness
- Measuring patient Experience
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12
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12
13
13
14
14
14
14
15
16
16
17
17
20
23
Part 3 - Key Developments & Improve net Priorities (2015/16)
3.1
Improved Complaints & Concerns Reporting and management
3.2
Further Accreditation & Registration (Quality Standards)
3.3
Clinical Outcome (PROM) Development
3.4
Our ‘Fit for Future’ Programme
3.5
Appendix 1- Glossary of terms
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26
27
27
38
30
2
QUALITY ACCOUNT 2014 – 2015
Introduction
Connect is the largest independent specialist community provider of Musculoskeletal (MSK)
& physiotherapy services to the NHS. Last year alone, Connect received over 150,000 MSK
referrals. 12 Clinical Commissioning Groups across the UK trust Connect to provide high
quality, safe, cost-effective and innovative approaches to care for their NHS patients.
Our consultant-led, multi-disciplinary teams operate to the highest clinical standards,
supported by the latest in technology, so patients have swift access to services and receive
seamless care. Using bespoke systems, patient referrals are quickly processed through our
Referral Management Centre, where we ensure patients with musculoskeletal conditions are
seen by the right people, in the right place, at the right time. This is crucial to improving
outcomes and patient experience, where better care in the community is delivered locally
and conveniently and ensuring unnecessary hospital appointments are avoided.
Our services are evidence-based and include self-management tools for patients, telephone
and web-based advice, access to diagnostics, face-to-face assessment & treatment and up
to date information resources for patients and GPs.
Current Services Provided
Connect is a specialist Musculoskeletal (MSK) care provider delivering:


Community MSK services for the NHS/Local Authorities (local public)
Occupational Physiotherapy services for employers (and their employees)
Our NHS community MSK services deliver the following:

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



Telephone triage (assessment & advice)
Clinical triage & CATS
Practice based physiotherapy
Consultant outpatient services (in the community)including Orthopaedic,
Rheumatology and Pain Management
Rehabilitation
Minor surgery including joint injections and US guided interventions
Podiatry
GP advice line
Referral Management Centre providing a single point of contact, all associated
administration and patient pathway coordination
Our Occupational Physiotherapy services deliver the following:


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
Assessment & Treatment Services commissioned by employers for their employees
Onsite and offsite occupational physiotherapy solutions
Pro-active(preventative) management of MSK disorders to support wellbeing and ‘fit
for work’ initiatives
Advice & Education (employee & management training)
3
Part 1
1.1 Chief Executives Statement
A Quality Account is an annual report that providers of healthcare services to NHS patients
must publish about the quality of services they provide. This is the first Quality Account
published by Connect, relating to the Community Musculoskeletal (MSK) Services we
provide to the NHS.
As well as showing our commitment to providing the best quality community services, the
Quality Account also provides an opportunity to look at what we have achieved and also
identify areas where we can make improvements next year.
We continue to collect a great deal of information on the quality of all of our services, within
the ‘three areas of quality’ defined by the Department of Health:



Safety
Clinical effectiveness
Patient experience
We use the information to examine our performance and to determine where further
improvements can be made. Areas for improvement and lessons learned from 2014/15
have now been built into our annual objectives and incorporated into our Clinical
Governance Framework and our Clinical Strategy for 2015/16.
At a time when demand is growing and budgets are shrinking, we continue to maintain
exceptional standards of patient care, offering a range of quality, patient-focused services
with low waiting times that consistently produce outstanding feedback from patients and GPs
alike.
Over the last few years, we have found that successful partnerships with NHS Trusts or
other Independent Health Care organizations is far more efficient and productive than
working in isolation. Through our own established partnerships we’ve proven that,
collectively organizations can cost-effectively adopt new models of care and adapt new
methodology, to improve patient experience and outcomes
Our staff are the backbone of our business and if patient and GP satisfaction is a true
measure of how they deliver care, then we should all be pleased with the success and the
feedback we have achieved to date. This is underpinned by our Core Values across the
business, namely:
Integrity:
we act with integrity in all we say and do
Positive:
we have a positive attitude to life and work
Supportive: we are supportive to the needs of our patients, colleagues and clients
Passion:
we are energetic and enthusiastic and have a genuine desire to make
a difference
Growth:
we believe that a commitment to personal growth and development will
lead to success for all
Delivery:
we understand the importance of doing what we say we will do and
delivering on time, every time
4
We believe our Clinical Governance Objectives and Clinical Strategy reflect the needs of
patients, commissioners and the people we work with, all of whom have contributed in
different ways to developing and informing our services over the years and recently our
2015/16 objectives.
We will ensure this is also the case when it comes to reviewing our services next year and
writing our 2015/16 Quality Account.
Andrew Walton
Executive Chairman
5
1.2 Medical Directors Statement
As Medical Director, my responsibility is to ensure that the clinical services we provide are
safe, effective, evidence based, up to date and of a high quality. This has been achieved
through the development in 2013 of our Clinical Governance Framework and more recently
our Clinical Leadership teams, both of which have provided guidance and support to our
clinical teams of Consultants, Doctors, Physiotherapists and other Allied Health
Professionals.
Working together with patients, commissioners and staff, we have developed our Community
MSK model of care and enhanced patient experience. Working with our NHS partners, we
have developed more integrated care pathways and created efficiencies whilst ensuring
quality and governance are maintained.
We will continue to measure our performance against national and local standards of care
and ensure that we learn lessons from any negative feedback or mistakes that we make.
Our Clinical Strategy for 2015/16 has defined 3 main areas of focus which will further
enhance the care that we provide to our patients, namely:
1. Develop Consistency & Excellence in Clinical Care
Review & Develop MSK Clinical Guidelines
Review & Develop Clinical Audit
2. Develop Clinical Leadership Teams
Develop Leadership Structure and training programmes
3. Ensure Excellent Clinical Service & Profile
Establish Research & Development links with Higher Education Institutions
Identify areas for innovation
Maintain high levels of CQC compliance
We look forward to continuing to delivering the highest standard of care to those patients
who currently access our service and also introducing ourselves to the new patients we will
meet, all of whom place trust in us to deliver effective solutions for the musculoskeletal
problems they are experiencing.
Dr Graeme Wilkes, Consultant (SEM)
Medical Director
6
1.3 Statement of Assurance
We confirm that this, our first Quality Account, presents a true picture of the quality of
services we provide, that the information is reliable and accurate and there are proper
controls over the collection and reporting of data.
We confirm that this Quality Account conforms with the Department of Health guidance and
is open to scrutiny and review.
30th June 2015
th
30 June 2015
Dr Graeme Wilkes, Consultant (SEM)
Medical Director
Andrew Walton
Executive Chairman
1.4 Further Information and Feedback
If you would like any of the following:
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
to give us feedback on any aspect of this Quality Account
a hard copy of this quality account
a copy to read it in a different language
to talk to someone about your experiences of our community MSK services
to find out more about how to access our services
please email customerservices@connectphc.co.uk or phone 01912504580
7
1.5 Quality Assurance & Quality Management
Quality Assurance at Connect is a priority. Our service standards are benchmarked against
local and national regulatory & legal requirements, as well as those defined through specific
bodies and organisations such as the Chartered Society of Physiotherapy, the General
Medical Council, the Health Care Professions Council, the Care Quality Commission and the
Health & Social Care Information Centre.
We undertake routine structured audits of our services, as well as external accreditation and
inspections.
Our ‘Whistle Blowing Policy’ and ‘Duty of Condor’ underpins our ‘no blame culture’ where we
impress upon staff the importance of learning from any errors or mistakes and apologising
where we are at fault so that we can improve services for the benefit of future recipients of
our care.
1.6 Regulatory Compliance
Care Quality Commission (CQC) Inspections & Compliance
Assuring good quality services delivery is incredibly important to Connect. Evidencing
quality assurance, allows us to govern, regulate and improve the service provided by our
physiotherapists and doctors across the company.
Connect are a Care Quality Commission (CQC) regulated provider for community MSK
physiotherapy services. We have a robust approach to internal quality assurance monitoring
so that we can benchmark ourselves internally and but also externally where possible.
Connect is registered with the (CQC) under the following ‘regulated activities’:
CQC Registration
CQC Organisation Identification number
Reference Number
1-151592833.
1. Transport services, triage and
medical advice provided remotely
2. Diagnostic and screening
procedures
FR25212_2_2
3. Treatment of disease, disorder or
injury
FR25212_2_1
FR25212_2_3
Since our registration with the CQC in 2011, Connect has had 2 inspections, once in Feb
2013 and also in Jan 2014, both of which Connect was deemed to have ‘met the required
standards’. As such, no enforcement notices or improvement plans have been issued and
Connect have no ongoing investigations with the Care Quality Commission.
For 2014 report see: http://www.cqc.org.uk/sites/default/files/old_reports/1181584100_Connect_Physical_Health_Ltd_INS1-672647664_Scheduled_26-02-2014.pdf
8
The categories inspected and overall summary of the inspection can be seen in the table
below:
CQC Standard Inspected
Date of
Standard met
Inspection
Care & Welfare of People who use the service

Consent to care & treatment
28/02/2013
24/01/2014
24/01/2014
Management of medicines
24/01/2014

Supporting workers
24/01/2014

Maintaining Records
24/01/2014

Respecting & involving people who use services
28/02/2013

Safeguarding people from abuse
28/02/2013

Managing complaints
28/02/2013

Requirements relating to workers
28/02/2013


HSCIC Compliance (IGSoC)
Connect is registered with the Health & Social Care Information Centre (HSCIC) and
undertakes annual accreditation. Connect has maintained its IGSoC accreditation of ‘Level 2
Business Partner’ status every year since 2011. This provides patients and commissioners
with confidence that all data and records are securely held/transferred by Connect and are
compliant with NHS Standards and the Data Protection Act.
1.7 Contribution to National Audit Databases
Within the National Clinical Audit and Patient Outcomes Programme (NCAPOP), there are
limited options for involvement in National Audit Database such as with schemes with
Healthcare Quality Improvement Partnership (HQIP).
However, the applicable National Audit Database contribution does include the National
Joint Registry (NJR). Within our Newcastle IMATT contract, through collaborative
arrangements we subcontract orthopaedic surgeons to work in a community MSK service.
These surgeons determine and select patients for operations such as joint replacements.
We have consistently contributed towards NJR for knee, hip, shoulder and elbow
arthroplasty in this contract. However, given the nature of our partnerships, the overall
contribution is provided by our partners where the arthroplasties (surgery) has taking place
ie in the acute hospital setting of Newcastle Upon Tyne Hospitals Foundation Trust.
9
Given the types of services (musculoskeletal services) we provide at Connect, there are no
other types of audits for long-term conditions that apply to the services we deliver. However,
Connect would like to work with HQIP in the future to explore whether there are opportunities
to establish MSK non-surgical care national audit areas within the National Audit Database
with professional bodies such as the Chartered Society of Physiotherapy (CSP) and other
professional networks, within the profession of physiotherapy. Connects National Clinical
Manager is registered as a member of NCAPOP and will work with HQIP to explore this in
the future.
1.8 Clinical Governance at Connect
At Connect, Clinical Governance is the heart of our business and company culture/ways of
working. It is used to support our patient-professional partnership, in order to for delivery
safe services, excellent clinical outcomes and patient experience.
Connect contributes to the National Audit database as well as Commissioning for Quality &
Innovation (CQUIN) Data.
Connect’s Clinical Governance Framework provides a vehicle for the safe implementation,
auditing and improvement of each individual service, incorporating staff and patient input,
evidence based practice, and regulatory/legal compliance within requirements of MSK
healthcare.
The mechanisms and infrastructure for clinical governance in place are clear, well
established and well communicated throughout the business, which can be implemented
with ease across numerous locations and adopted consistently across a range of service
models.
This allows us to effectively meet the needs of our clients who include commissioners,
patients, GPs and staff. It is essential at Connect for Clinical Governance to reach every
level of our healthcare organization to work effectively.
This structure starts with the 7 pillars of clinical governance are outland here which Connect
have adopted:
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Under each pillar of clinical governance, we have a series of systems, processes policies,
procedures that underpin the delivery of this framework.
This structure allows for local ownership of Clinical Governance, balanced against the need
to analyse, monitor and reporting on the delivery of safe and effective healthcare under
delegated responsibility throughout the organisation.
Connect’s business audit design process, allows for a great opportunity to:
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Benchmark quality standards between services internally
Benchmark against external standards where these are published.
Identify training needs and service improvements to meet agreed standards of care
Participate in future national audit and research- such as through Healthcare Quality
Innovations Project (HQIP)
The CG framework ensures a cyclical process of Continuous Improvement of service quality,
ensuring standards are maintained, delivery is re-evaluated and healthcare models are
refined for the benefit of patients, commissioners and staff. These are reviewed quarterly at
our Clinical Governance Group (CGG) Meetings as well at local & regional Clinical Steering
Group and Contract Service review meetings.
With Connect being a multi-centre MSK provider on a local as well as national level, we have
the unique opportunity to internally as well as externally benchmark our services to assure
that quality standards are being maintained and the approach in our Clinical Governance
Framework, which underpins the delivery of quality & safety, is being met across all our
services.
We will showcase examples of this here in this Quality Account.
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Part 2
Key Successes & Achievements (delivered to date)
Over many, but particularly in recent years, we have achieved a number of key successes
which meet the DoH criteria within this Quality Account, namely; ‘Safety’, ‘Clinical
Effectiveness’ & ’Patient Experience’.
2.1 Innovating the MSK pathway – Newcastle West Pilot
In 2011/12 Connect partnered with Newcastle West Clinical Commissioning Group
(NWCCG) and Newcastle upon Tyne Hospitals NHS Foundation Trust to establish an
innovative pilot to try and reform local MSK services. The results were exceptional. Details of
the pilot and video clips of service users’ experiences (patients & commissioners) can be
found in the following link:
http://www.connectphysiotherapy.co.uk/connect-the-nhs-2/newcastle-west-pilot/
Working with nine local GP surgeries and a total patient list of over 77,000, NWCCG
commissioned Connect to undertake a MSK pilot study for two years (2011 & 2012). Other
than defined exclusions, GPs referred all patients to the community service, leaving the
decision to access secondary care to the MSK CATs service itself.
The new physiotherapy service was sited in numerous GP practices to improve access and
reduce wait times for patients. Every referral was sent to Connect’s specialised ‘call &
referral management centre’ (RMC). This meant patients were contacted, screened and
booked into appointments promptly and efficiently.
Telephone triage (known as PhysioLine) was introduced so patients could receive immediate
guidance & advice over the phone, from the comfort of their own home. Sports, exercise
and orthopaedic specialists were included as part of the clinical team so patients had
specialist care in a convenient and accessible location - in the community.
The Results:
Improved waiting times for appointment in pilot service (working days)
Physioline (Telephone)
Physiotherapy ( face to face)
MSK CATS (Diagnostics and/or Injection )
2
6
19
Improved GP & onward referrals for MSK conditions
GP Referrals to:
2010
2012
% Variance
Orthopaedics
Rheumatology
760
252
455
231
-40%
-8%
12
Neurosurgery
CATS
Physiotherapy
Total
87
424
860
49
769
2356
-44%
+81%
+174%
2,383
3,860
+62%
Improved patient experience with new service model
Overall, how would you rate the
PhysioLine Service?
33%
Overall, how would you rate the
care you were given by CATS?
16%
18%
3%
0%
81%
8%
40%
Excellent
Fair
Very Good
Poor
Good
Very Poor
Excellent
Very Good
Good
How would you rate the care you
were given by the physiotherapist?
8%
0%
92%
Excellent
Fair
Very Good
Poor
Good
Very Poor
Widespread GP Support
97% of GPs rated the reformed MSK service ‘better’ or ‘much better’ than 2010
13
79% of GPs rated the service as an improvement for patients
Reducing waiting times & costs to the NHS whilst improving delivery
The pilot delivered 62% more patient care in 2012 than 2010, whilst reducing overall
expenditure and waiting times. In just six months, the pilot saved the NHS £42,000 (£80k
pa) for only a relatively small population of patients.
Direct access to surgery
Appropriate referrals, assessment and investigations as well as direct access to surgical
consultants in the community meant that appropriate patients only were fast tracked through
hospital surgical lists and received speedier treatment (which also made best use of
consultant’s precious time).
Improved Clinical Outcomes
Validated Patient Reported Outcome Measures (PROMS) were used during the pilot (EQ5D
-5L) which demonstrated statistically significant improvements as compared with the
previous model of MSK care.
Effective Partnership Working
The pilot clearly demonstrated that a partnership that works between a CCG, Foundation
NHS Trust and an independent NHS provider can be cohesive, cost-effective and produce
outstanding results for the NHS and its patients.
The Commissioners Experience
"The pilot service that we have been running has been a great success. Popular with
patients and with GP’s, the service has been shown to be responsive, of high quality and
cost-effective. The rapid community based physiotherapy response has been highly valued,
as has the expanded Intermediate CATS service using extended scope physiotherapists,
secondary care consultants and a Sports Exercise Medicine (SEM) consultant. The inclusion
of secondary care consultants has helped fully integrate the pathway. The collaborative
working of these specialists in community settings has been a major achievement and the
SEM consultant has been central in building these arrangements."
Dr Guy Pilkington, GP Chair for Newcastle West CCG
14
2.2 Award Winning Services - Leadership award
Chartered Society of Physiotherapy (CSP)
http://www.csp.org.uk/frontline/article/gateway-new-approach-vanessa-haycocks-awardwinning-msk-service
When Vanessa Haycock spoke to Frontline about winning a prestigious CSP leadership
award, the head of community physiotherapy in west Newcastle for Connect Physical Health
immediately mentioned the team effort that made her success possible.
‘Even though it’s a leadership award, we’ve taken it very much as a team award,’ is her view
of the accolade. It recognises Mrs Haycock’s role heading a 13-strong physiotherapy team
during in pilot, which began on 1 January 2011, to establish a community musculoskeletal
(MSK) service in the west of Newcastle.
Mrs Haycock said she believes that a successful service is built by ‘knowing what your
patients want – and not assuming what they want’. But she adds that it was important to
keep GP satisfaction high, and says she encouraged the Connect team to build relationships
with GPs and commissioners.
Connect used the EQ-5D standardized measurement of its services during the pilot, a
measurement the Chartered Society of Physiotherapy (CSP) is keen to promote. The
change in EQ-5D results for the physiotherapy service provided during the pilot was
described as ‘statistically significant’.
The Patients Experience
“The benefits of Connect Physiotherapy are numerous and I couldn’t recommend it enough.
Short waiting times and being able to receive treatment at my local GP surgery really helped
my situation.”
Mrs Julia Watts, West End, Newcastle upon Tyne
“I was at the end of my tether and made an appointment with my GP who recommended
physiotherapy to help ease the symptoms and the pain I was feeling. I called Connect that
day and they were able to assess me over the phone, offer advice and refer me to a
physiotherapist the following week in my local area.”
Mr George Kernan, Sunderland
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2.3 New 2015 MSK Commissioning Model
One new contract win of note, is within the NHS in South West Essex, which recently went
live in April 2015. It is the first occasion that an NHS Acute Trust provider organisation (as
opposed to a commissioning one) has outsourced a community MSK service to the
independent sector. The service is already delivering greater integration and improved
patient experience as waiting times drop, with consequent reductions in cost. By proving this
model, we hope to learn from our experiences though feedback from patients, referrers and
commissioners, which will in turn inform further service improvements and open
opportunities for Connect to work in an integrated way with other hospital trusts, in order to
help them achieve their objectives.
The Commissioners Experience:
“Connect have taken a refreshing approach to partnership working with the Trust, with an
emphasis on building up the relationship and establishing trust between the key parties. We
have had an open and honest dialogue and Connect have clearly demonstrated that they
have expertise in designing patient-centred services that deliver positive outcomes.”
Emma Timpson, Deputy Commercial Director, Basildon and Thurrock University
Hospitals NHS Foundation Trust
2.4 Community MSK Service Development (Listening to
Patients, GP’s & Commissioners)
An example of overcoming challenges and developing services is well demonstrated in our
Camden service in London.
The service was established to deliver a community MSK service and has been successfully
delivered through integrated working with 2 large acute trusts including the Royal Free
Hospital and University College Hospital, a community NHS trust, the local authority for
physical activity, three diagnostic providers, the national centre for sports medicine and the
third sector.
The service has developed to meet local population and commissioner needs, has recently
been extended to include MSK pain management and we are currently working with Public
Health and the Institute of Sports and Exercise Health to develop a highly innovative
pathway that is focussed around prevention of chronic disease. This service is held in very
high regard by Camden CCG, GPs and patients as a good and well-integrated service,
where the following improvements have been made:


Multi provider working – ensuring that the collective expertise is valued and used as
effectively as possible so that the right people are involved and engaged early to
deliver a truly effective pathway
Pathway design – building services around the patient to ensure an holistic patient
centred approach is adopted
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
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

Identifying interdependencies and developing integration between services to ensure
seamless communication & high quality patient care
Single point of access, ensuring patients are directed quickly to the right place, right
clinician at the right time for the right treatment/management and with the most
effective use of resources
Improved capacity and demand management to ensure that the new service and
pathway configuration can work
Patient needs – diverse patient are more accounted for with the new service and with
delivery flexible enough to react to each patient as an individual
Identifying and understanding local needs, demographics and key relationships was
essential to overcoming challenges. Early contact with each provider and open discussion of
the clinical pathway initiated on-going relationships. Communication and early engagement
has ensured that all linked organisations, our own team and our patients understood how we
should work together for optimum patient care, measured through patient feedback &
experience as well as outcomes measures and audit.
2.5 Some Results of Our Clinical Audits
Connect undertakes 12 different types of ‘essential clinical audits’ and these are monitored
through robust reporting systems, with local teams owning responsibility to complete these.
Over the past 12 months, Connect have invested heavily in clinical audit infrastructure, such
as improved reporting systems and appointment of Regional Clinical Leads which in turn has
directly supported the delivery, completion and effective use of the data from clinical audit to
inform and improve services. Below is a summary the monitoring process and the
improvements we’ve made this year on completing the 12 clinical audits per service per
year:
Patient Safety Audits:
Clinical Audits Completed & Reviewed over
the year 2014-15
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Q1
Q2
Q3
Q4
17
Further, as a result of our internal benchmarking systems, we can provide visibility of this to
our national Clinical Governance Group against quality standards for our national contracts,
allowing us to internally benchmark our services. An example of this is the Diagnostic
imaging referral quality audits outlined below by national services:
Diagnostic Imaging Quality Audit: Evaluation of
Compliance with Royal College Radiology
Guidelines:
MRI referrals 2014-15
Northumberland IMATT
North Tyneside IMATT
Seaham CATS
Sunderland CATS
Gateshead CATS
Newcastle IMATT
Camden CATS
0%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Diagnostic Imaging Quality Audit: Evaluation of
Compliance with Royal College Radiology
Guidelines:
Xray referrals 2014-15
Northumberland IMATT
North Tyneside IMATT
Seaham CATS
Sunderland CATS
Gateshead CATS
Newcastle IMATT
Camden CATS
0%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
18
Diagnostic Imaging Quality Audits:
Evaluation of Quality improvements over time
2013 to 2015
100%
80%
60%
40%
20%
0%
MRI
Xray
2013-14
2014-15
What does this tell us about patient safety?

For all services where referrals for diagnostic tests are completed as a part of clinical
care, 96% of X-rays and 90% of MRIs consistently meet Royal College of Radiology
guidelines. This has been fed back to individual clinicians and where required training
and development to support their clinical care delivery has been completed. (Graphs
above show more detail)

Our physiotherapists and doctors diagnose serious pathology very well and manage
their care very quickly as per NICE guidelines, with 94.7% of patients being referred
for the investigation of choice on the 1st appointment in Newcastle IMATT contract for
example

Clinical ‘paper triage’ is highly effective when completed by advanced trained ESP
physiotherapists for MSK services when good guidelines and training support this
activity.

Infection control standards of sharps disposal and segregation of healthcare waste
are strongly embedded in practice (as outlined by NICE and Health & Safety
Executive)

Although we meet targets for response rates for completing written responses for
patient complaints very effectively, the quality of some patient written complaint
responses could be improved in the company and training for staff is required. This is
now being planned

The documenting of clinical consent for treatment has been excellent in all contracts
across the company

Utilising standard audit systems allows for internal benchmarking to enhance our
internal quality assurance. This has proven to be effective to focus quality
improvements and recognise and reward excellent quality within our teams
19

Providing local clinical leadership is essential for quality assurance.
Evidence of Clinical Effectiveness
In order to provide quality clinical care which meets national standards, it is important to
continually determine whether the treatments provided are clinically effective in order to
provide optimum improvement and recovery of patients, whist ensuring we are seeing the
“right patient, in the right place, at the right time”.
At Connect we measure clinical efficacy and importantly throughout this year have focused
on key successes including:



Use of patient reported outcome measures (PROMs),
Serious diagnoses evaluation
Priority appointment scheme development.
Patient Reported Outcome measures (PROMS)
Measuring and recording the outcomes of patient’s clinical care is important for everyonepatients, clinicians, managers and commissioners of services. At Connect, we want to be
improving patients’ quality of life and measuring how well we do this is essential to
confirming we are clinically effective.
In MSK physiotherapy, the PROM of choice is EQ5D which is a ‘validated’ PROM
designed to evaluates patients ‘quality of life’ before and after any clinical intervention.
EQ5D is the outcome measure of choice for MSK physiotherapy as championed by NHS
England (Department of Health) and the Chartered Society of Physiotherapy (CSP).
At Connect, we are developing our capabilities to consistently and regularly report on
PROMs using EQ5D and have, over the years, piloted use of EQ5D in a number of
services, to determine clinical effectiveness in all its contracts.
Some of the EQ5D data that has been produced from pilots recently have shown us
interesting results and in one pilot in Newcastle West Physiotherapy, this demonstrated
the following over a 3 month period post physiotherapy treatment:
1
0.9
0.8
0.7
0.6316
0.6
0.5
0.4369
0.4
0.3
0.2
0.1
0
Baseline
3 Month Follow Up
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What does this tell us about clinical effectiveness?


This change in EQ5D score denotes a significant improvement in quality of life
with even a short period of physiotherapy treatment and intervention in community
setting
We will continue to grow and internally benchmark our services against scientific
evidence and contribute with any HQIP initiative regarding this, as they develop
the National Audit Database for this type of healthcare service.
Serious diagnoses evaluation
When a patient presents with a muscle or joint problem to their physiotherapists or to their
specialist clinician in a CATS clinic, it is recognised that an important part of the clinical
consultation is to screen for serious diagnoses and redirect these patients for either
tests/investigations, to a more specialised provider or to emergency care.
Connect have completed audits of confirmed and suspected serious diagnoses in
patients referred in 2014/15, in order to learn more about their service delivery but also to
ensure that these patients when diagnosed, are managed appropriately in line with
national clinical guidelines (such as those by NICE).
Below is a breakdown of the services in the North of England called NE CATS & IMATT
in 2014-15 and the types of confirmed serious diagnoses that were made in the service:
NE CATS & IMATT 2014:
Confirmed Serious Diagnoses:
Break down of diagnosis type
Fracture (18)
Malignancy (23)
Infection (5)
Medical such as AAA (3)
AVN (3)
In addition, 88.7% of patients with confirmed serious diagnoses were referred by
our clinicians and ‘imaged’ on their first appointment (100% were sent for a tests
or investigation within 2 appointments)
What does this tell us about clinical effectiveness?

Our clinicians are making sound clinical judgement on serious diagnoses from
the patients they are seeing and are not missing these in consultations. We
can take confidence from this that we are treating the right patients with the
right care at the right time
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
Clinical care was moved on very swiftly for all patients with a serious
diagnosis

Clinical triage was incredibly effective- All of these confirmed serious
diagnosis patients, had no indication of red flags (ie worrying sinister features)
when assessed by their GP prior to referral to Connects MSK specialist
clinician

Some hospitals had poor timescales for returning investigation reports to our
Referral Management Centre with a range from same day to 22 days. We
have identified this with local hospital radiology departments and are working
closely with them to improve this

There is an absence of a Metastatic Cord Coordinator (MCC) in the North
East of England. This role is outlined as essential role outlined by NICE MCC
Guidelines. Connect have and continue to work with Commissioners of NHS
services to help improve this. It is interesting to note that in our Nottingham
MSK contract, there is this MCC coordinator in place and in this service;
these patients have a more streamlined source of care. Connect are sharing
these lessons learned with local commissioners to help inform important
service design changes
Priority appointments
Earlier in late 2014, a patient made a complaint about their experience in one of our
services. On evaluation of the main issues about his care, we realised that actually
his care could have been moved on to a more specialist service quicker if we had a
better Patient Prioritisation Procedure.
When we reviewed this alongside other incidents and complaints, we noted
improvements could be made if we offered “Priority appointments” to patients for
quicker/better healthcare access.
This was particularly relevant if they are having a more significant problem such as:
- The patient is off work due to their MSK problem
- The patient is significantly affected by this problem interfering with their life
considerably
- Their condition looks clinically more urgent and requires more priority
assessment
- After surgery rehabilitation / treatment is required within in certain timelines
We completed the pilot and have since extended this across the company and into all
other contracts, during 2014/15, with great success noted. This means that we can
respond more effectively to meet patients’ needs and improve quality and
effectiveness of care.
What does this tell us about clinical effectiveness?
After the pilot was completed, we conducted an evaluation of the impact of this
change within appointment booking systems and determined the following:
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
100% of patients were offered an appointment from ‘same day’, to up to 5
days from receiving referral

100% of the patients who were identified as Priority were clinically appropriate
for priority status, as evaluated by Clinical Lead Physiotherapist

58% of priority patients required urgent tests or investigations

15% required urgent hospital referrals

Patients requiring non-surgical treatment, were referred much quicker than
previous models of working

7% of the patients who had tests had confirmation of serious diagnoses
(which is higher than the rate of serious diagnoses nationally for audits). This
means we identified these patients and directed their care more effectively

Of these serious diagnoses, the care was moved on considerately quicker
than if they remained in previous care models
 By offering Priority or urgent appointments for patients, we can signpost
patients to “the right person, at the right place, in the right time”
We provided feedback to local GPs who made these referrals to our services to help
educate GPs on more appropriate signposting of care and worked collaboratively
with Commissioning GP leads to help consider educational topics for local GPs with
this audit data in mind.
This has proved to be not only clinically effective for better care, but also did not have
a negative cost implications on the service either as all of the appointments were
used, resulting in no wasted appointments.
Measuring Patient Experience
Providing excellent patient-centred care is at the heart of Connect’s clinical philosophy of
healthcare as well as its clinical strategy. This means providing a ‘positive patient experience’
as well as good clinical outcomes of care.
An important part is ‘listening to patients’, obtaining feedback and also providing mechanisms
for regular canvasing of patient experience (good and bad) including concerns and formal
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complaints. Importantly, it’s what’s done with this information, how it is used to inform service
design changes and what improvements can be made to service delivery that optimises the
quality of care and experience of patients.
Over this past year, Connect have invested in a patient experience measures (PREMs) survey
& collection systems known as Customersure, which can be accessed by patients either on
line, via email or on paper. This has also been aligned with the redeveloping of our approach
to recording and evaluating Patient Concerns & Complaints.
Patient experience measures (PREMs)
Across all of our contracts we standardly utilise a patient feedback survey, which is short and
quick to complete. The questions address the key components of quality healthcare
including Friends and Family rating. Patient feedback forms are distributed via post, face to
face and via an online application to meet patient needs.
For the financial year of 2014/15, we have had a response rate for NHS services around 411% over the year and are aiming for a target of 25% in line with national data from NHS
England on patient satisfaction surveys. Below is a summary of the quality marks the
patients have provided evidencing consistently high marks over this year:
Patient Experience Measures (PREMs)
Quality Measures
Year to date 2014/15
10
8
6
4
2
0
We also regularly complete additional patient feedback for contracts which aim to address
questions of interest to local NHS Commissioners. The feedback and response rate has
been excellent. An example of results from feedback on our Sunderland Community MSK
service in September 2014 are listed below:




97% of patients stated the physiotherapist had listened to concerns and
answered their questions
96% of patients felt they were definitely kept informed and involved in decisions
about their care and treatment
99% of patients understood the aim of the treatment given
94% rated their experience as good to excellent
We have used this data from patients’ voices and feedback forms to produce action plans,
service improvements and feedback to front line clinical and administrative staff. This patient
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data has been evaluated over time and we made some significant positive changes by
improving our services including:




Improving signage in venues
Increasing choice of female or male clinicians
Ensuring our administrative staff offer more choice of locations to patients
(improved from 89-94%)
Addressing some training needs in relation to communication skills for clinicians
We have seen improvements in patient experience measures as a result of these changes
and also a reduction in patient complaints that had been trends we had seen previously.
What does this tell us about patient experience?

The vast majority of patients have a very good/excellent experience with the
services Connect and its staff offer

Listening to patients helps improve quality of service delivery by identifying
themes from patient experience measures to reinforce excellence in practice but
also to re-evaluate and redesign portions of the service by using service users’
feedback

This ‘Continuous Improvement’ approach at Connect not only improves quality of
care delivered, but also continues to enhance the experience of the patients in
the service.
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Part 3
Key Development & Improvement Priorities for 2015/16
In line with our Clinical Strategy we have identified some key development & improvement
priorities for 2015/16
3.1 Improve Complaints & Concerns Reporting &
Management
Connect’s philosophy on complaints management is to investigate and resolve all complaints
effectively, in the shortest time possible, with candour and transparency. This includes
carrying out a full investigation which is focused on resolution of the concern or complaint,
where possible to the satisfaction of the complainant, whilst being entirely fair to the staff
involved. This will involve a verbal or written explanation to the complainant and an
immediate apology where called for.
We have robust systems and processes to manage complaints and concerns from patients
and generally do so very well. We continue to invest in the skills of staff and managers to
resolve concerns and complaints effectively.
Connect are aware that there are some areas for focus and improvement regarding how
concerns and complaints are reported and managed including:



Improved ability for all staff to locally resolve and manage patient concerns at
the source to provide local immediate resolution – we are investing in
consultation and communication skills training
Improved consistency of quality of written complaint responses – we are
investing in training for managers
Improved data reporting regarding incidents and complaints- we are looking at
ways of developing our reporting capabilities to be more efficient and effective
and to allow local managers to self-monitor, capture data and trends better
Within this year, we have commenced redesign of our policies and procedures and have
already initiated some training for managers and front line staff. Where this has been put in
place, we can already see an improvement in the quality of written complaint responses and
also of the ability of local teams to resolve local issues more effectively and with greater
patient satisfaction measures from PREMs.
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3.2 Strengthen our Clinical Leadership Structure
Connect has formally structured its clinical leadership to ensure a safe and high quality
service is provided throughout. Our defining principle is that responsibility for clinical
governance starts with clinical teams within any local service and cascades upwards until
reaching the senior, responsible clinicians who are the National Clinical Manager
(physiotherapist) and the Medical Director (Consultant). In 2015/16, the structure outlined
below will be implemented across all Connects services & regions:
At the base, governance is essential in everything clinicians do and is supervised by clinical
team leaders who will be responsible for a group of clinicians in their sub-specialty area.
Information is cascaded upwards through a series of reports and meetings. The team
leaders meet with the regional lead physiotherapist/doctor at the clinical steering groups.
This restructure will afford more ‘local accountability’ as well as overall improved visibility
and reporting on Clinical Governance
3.3 Maintain & Develop Accreditation & Registration to
improve Quality
Connect currently does not meet the threshold of requirement for a Monitor Licence. In
2015/16 this threshold will be reached and Connect intends to register, be monitored by and
be accountable to Monitor.
In addition Connect is considering achieving BS ISO 9001 Quality Management Standards.
We believe both of the above will further drive valuable improvements in our Quality systems
and processes throughout the business.
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3.4 Clinical Outcome (PROMs) development & EQ5D
roll out
EQ5D is the standardized ‘measurement of effectiveness of physiotherapy’ supported by the
Chartered Society of Physiotherapy (CSP), which they are keen to promote.
The CSP says the EQ-5D-5L measure is non-contentious, easy to read and understand,
validated and takes approximately two minutes to complete.
We have struggled as a multi-provider company in the community, to deliver EQ5D (now our
clinical outcome measure of choice) consistently across all services, in a manner that is
efficient, as well as effective. Within this financial year we be investing in improved systems
as well as the appointment of a Project Manager to oversee PROMs development and
implementation the local Community setting and also nationally as a multicentre
organisation.
We will internally benchmark our services against scientific evidence and contribute with any
HQIP initiative regarding this, as they develop the National Audit Database for the type of
healthcare service we deliver
3.5 Our ‘Fit For Future’ Programme
‘Fit for Future’ is one of the main programmes of work being undertaken by Connect,
underpinning the organisational growth & development strategy and is based upon three key
themes:
Standardise – delivering our services as efficiently as possible
Develop – improving upon the strong foundations we already have
Innovate – maintaining competitive advantage
Standardise
One core business proposition
Rationalisation of business systems
Rationalisation of patient pathway
Develop
Build on core business proposition
Continually improve business
Referral Management Centre (RMC) processes
- across the business
Staff skill base
Multidisciplinary teams throughout
Patient/ customer access channels
Consistent use of technology
Understand how existing
technology can improve services
Innovate
Our People - providing multidisciplibary care
Our Processes - new & efficient
ways of delivering quality services
OurTechnology - cutting edge
technology
Our Products/Services - that solve
modern healthcare problems
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Fit For Future Developments and Innovation

People
o Investment in People to meet demands of changing services (shift in secondary
care activity and increase in prevention)
o Clinical skills development with Shared Decision Making (Improving
consultation skills)
o Leadership skills development

Processes
o Identify and implement process improvements & efficiencies
o Outcome measurement (PROMS)

Technology
o Implement New IT platform
o Enhance Patient Self-management & Prevention support

Products/services
o Exercise-based rehabilitation
o Biopsychosocial Model
o Pain Management
o Minor Surgery
Significant investment in our Fit for Future programme will be made in 2015/16, which will
benefit patients, staff and commissioners, ensuring that we are the Number 1 Quality MSK
provider in the UK and the employer of choice.
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Appendix 1
Glossary of Terms
Adverse incidents
Any event or circumstance arising that could have or did lead to serious unintended or
unexpected harm, loss or damage.
Care Quality Commission (CQC)
The Care Quality Commission is the independent regulator of health and social care in
England.
It regulates health and adult social care services whether provided by the NHS, local
authorities, private companies or voluntary organisations. Visit: www.cqc.org.uk
Chartered Society of Physiotherapy
Chartered society of physiotherapy (CSP) is the professional governing body for
physiotherapists as a profession. Further they are the trade union for physiotherapists.
http://www.csp.org.uk/
Clinical audits
A systematic process for setting and monitoring standards of clinical care.
‘Guidelines’ define what the best clinical practice should be, ‘audit’ investigates whether best
practice is being carried out and makes recommendations for improvement.
Commissioning for Quality and Innovation (CQUIN)
A payment framework that has been a compulsory part of the NHS contract from 2009/10. It
allows local health communities to develop their own schemes to encourage quality
improvement and recognise innovation by making a proportion of NHS service provider’s
income conditional on locally agreed goals.
Community services
Health services provided in the community, for example health visiting, school nursing,
community nursing, special dental services, physiotherapy, podiatry (foot care).
Healthcare
Healthcare includes all forms of healthcare provided for individuals, whether relating to
physical or mental health
Health care and professions council (HCPC)
Health care and professions council (HCPC) are the professional regulator for
physiotherapists as an allied health professional. They are responsible for registration and
re-registration for licence to practice for physiotherapists and ensure that all registered
physiotherapists adhere to the Standards of proficiency (Fitness to practice). Further the
HCPC approve the quality of training programmes and maintain a register of professionals
who have met the proficiency standards to practice. http://www.hpc-uk.org/
HQIP
Healthcare Quality Improvement Partnership. Visit: http://www.hqip.org.uk/
Musculoskeletal (MSK)
Parts of the body involved with movement and function, such as bones, joints, muscles,
ligaments, tendons, nerves.
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National Institute of Health and Clinical Excellence (NICE)
NICE provides guidance, sets quality standards and manages a national database to
improve people’s health and prevent and treat ill health.NICE makes recommendations to
the NHS on:
 New and existing medicines, treatments and procedure
 Treating and caring for people with specific diseases and conditions
 How to improve people’s health and prevent illness and disease
Visit: www.nice.org.uk
National Patient Safety Agency (NPSA)
The National Patient Safety Agency is an arm’s-length body of the Department of health,
responsible for promoting patient safety wherever the NHS provides care.
National patient surveys
The National Patient Survey Programme, coordinated by the Care Quality Commission,
gathers feedback from patients on different aspects of their experience of recently received
care, across a variety of services/settings.
Patient Reported Outcomes (PROMs)
PROMs assess the quality of care delivered to patients by measuring ‘outcomes’ or the
‘tangible effect of care’ on the patient.
Physiotherapy
Registered and qualified practitioners skilled in the assessment and treatment of conditions
relating to the human body, that limit or impair movement & function (temporarily or
permanently).
Research
Clinical research and clinical trials are an everyday part of the NHS. The people who do
research are mostly the same doctors and other health professionals who treat people. A
clinical trial is a particular type of research that tests one treatment against another. It may
involve either patients or people in good health, or both.
Root Cause Analysis
Root Cause Analysis (RCA) is the structured approach to identifying the factors which
resulted in an incident. The root causes are the fundamental issues which lead to the
incident happening and must be addressed to improve the delivery of care.
Safeguarding
A term used in conjunction with measures that are taken to protect, safeguard and promote
the health and welfare of children and vulnerable people, ensuring they live free from harm,
abuse and neglect.
Secondary Uses Service (SUS)
The Secondary Uses Service is designed to provide anonymous patient-based data for
purposes other than direct clinical care such as healthcare planning, commissioning, public
health, clinical audit and governance, benchmarking, performance improvement, medical
research and national policy development.
Serious Untoward Incidents (SUI’s)
Essentially serious incidents are which cause (or have the potential to cause) the most harm
either to individuals (staff, service users, visitors, contractors, others) or to the organisation.
These include unexpected deaths; injuries causing admission to hospital; major and
31
permanent physical or psychological harm; large-scale theft or fraud; outbreak of disease;
major fire or flood; etc.
Further Information and Feedback
If you would like any of the following:





to give us feedback on any aspect of this Quality Account
a hard copy of this quality account
a copy to read it in a different language
to talk to someone about your experiences of our community MSK services
to find out more about how to access our services
please email customerservices@connectphc.co.uk or phone 01912504580
Central Office: The Light Box, Quorum Business Park, Benton Lane, Newcastle upon Tyne, NE12
8EU
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