MSK Clinical leaders Network Agenda Welcome and introductionsRachel Wakefield (AD Planned Care programme) and Geoff Watson (Clinical Director Planned Care Programme) PurposeThis meeting is an opportunity to critically review progress, and to identify and agree actions for 2012 that will have the greatest impact on supporting progress and implementation in the following areas:- Areas of Work:- 1. 2. 3. 4. 5. 6. ICATS StarTBack Pain services Enhanced recovery in orthopaedics Shared decision making/decision aids PLCV Improvement Indicators • LOS for hips and knees- decreased • Same day admission for hips and kneesincreased • GP out-patient referral (all specialities) 5% below 11/12 • Total elective FFCEs- 0.2% below 11/12 ICATS Activities•Robust model developed by CLN •Adoption across SC of many aspects of aboveas demonstrated in following slides:- Overview of ICATS or Similar Services Integrated Clinical Assessment and Treatment Services or Similar GP NOC, Care UK Bracknell BHFT Assura Southern Health NHS Solent IOW NHS PTC Cluster ICAT Service Provider or similar & area covered Oxfordshire & Buckinghamshire NOC Interface Service - Oxfordshire NE Interface Hub – North East Oxfordshire Care UK (MusIC) - Buckinghamshire Berkshire Bracknell CCG –(CATS), Berkshire East Berkshire Healthcare FT – Berkshire West SHIP •Assura – North Hampshire •Southern Health (Orthopaedic choice) South East Hampshire, (ICATS) Mid Hampshire •Solent – Portsmouth • St Mary’s Hospital Acute Trust - IOW Service Provider Services Geograph ical Patch Prevention & Education Services Use of Decision Aids & Informed Decision Making or STarTback Tool Outcomes Monitoring Arrangements Care UK P, ESP,JI,Dia Buckingha mshire Provided to GPs & Patients STarTback tool via referal form Outlined in contract monitored on a quarterly basis Solent P,ESP,JI,Dia,Pa, Po,Psy,DL (for podiatric surgery service), service has access to OT through Solent contract. Diagnostic ultrasound provided by physios. Self referral available to all patients. Portsmouth Provided to GPs & Patients STarTback Tool Informed decision making tool Outlined in contract monitored on a monthly basis NOC ESP, Cons, JI, Dia, Rh, Po, Oxfordshire Provided to GPs & Patients Decision aids, informed decision making Outlined in contract, monitored on weekly (some initially for 18 months- now monthly) and rest monitored on a monthly basis. NE MSK Hub P, Con, JI, Dia (refer for), Rh, Po, HF Oxfordshire Provided to patients Informed decision making Outlined in contractmonitored annually Service Provider Services Geograph ical Patch Prevention & Education Services Use of Decision Aids & Informed Decision Making or STarTback Tool Outcomes Monitoring Arrangements Southern Health (Current provision Con (for some pathways, not all yet), ESP, JI, Dia, DL (TCI card completed) SE Hampshire SW (Soton City and West Hants CCGawaiting update Provided to GPs & Patients Scoring tools eg STarTback used by some pathways, not all yet Outlined in contract – monitored and reviewed on a monthly basis Southern Health (Future Provision – starting Nov 11) Con, ESP, JI, Dia, Pa, Psy, DL SE Hampshire Provided to GPs & Patients Scoring tools used across all pathways Outlined in contract – monitored and reviewed on a monthly basis Southern Health (ICATS) October 2011: ESP and Con, JI, Dia, January 2012: Pa, Rh, Dl Mid Hampshire Provided to patients Threshold tools used by General Practice; Patient Decision Aid used by Patients Specific Outcome Measures developed Isle of Wight NHS PTC Provider (St Mary’s Hospital Multi Professional Triage Team for Lower Limb & Spinal P, GPwSI, JI, Pa, Po, Psy, HF, DL IOW Provided to GP’s and patients Integrated Pain Preassessment Questionnaire with Chronic Pain and Spinal MPTT service Outlined in service specification within Acute Standard Contract and monthly monitoring Berkshire Healthcare Foundation Trust ESP, P, community spinal service West Berkshire No Use of SDM and DA in discussion with CCG. Plan to be within pathway. Outcome of referral to CAS monitored Stand alone provider MSK CATS Not known Not known Not known East Berkshire How do we measure success of an ICATs Service Have we reduced Outpatient Attendances? Directly Standardised MSK Outpatient Attendances by Commissioner 1800.0 DS Rate by PCT Population 1600.0 1400.0 1200.0 Overall Reducing slightly 5QE 5QD 5CQ 1000.0 800.0 5QF 5QG 5QC 600.0 400.0 200.0 0.0 5L1 5QT 5FE All StarTBack – What is it? STarT Back Screening Tool (SBST) •9 Question screening tool designed for non-specific LBP patients in primary care •Developed, researched and validated by Keele University •The score identifies the level of risk that patients have of developing chronicity out of low, medium and high risk. StarTBack Scoring Flow Chart Total Score 3 or less 4 or more Sub score Q5-9 3 or less Low risk Medium risk 4 or more High risk StarTBack Activities•Presentation at MSK event •Production of DVD •Adoption in many ICATS •Funding for local implementation in primary care StarTBack- ? Next steps • Commencement of 3 implementation sites • Learning set and virtual interest group • Dissemination of update/progress reports and findings Pain Services Activities•Pain self-management featured in MSK event •Interest across region in developing selfmanagement services- adoption in some ICATS •Innovation Funding to Buckinghamshire & Portsmouth Pain Services- ? next steps • Conference call with Alf Roberts- colleagues in SC seeking input re self-care pain management • Opportunity to share progress from Portsmouth and Buckinghamshire • Integration of pain service into ICATS (Pain summit 2011) • Pathway development for linking primary and secondary care to improve care for people with knee pain or shoulder pain- COBIC. National Programme Specialties Enhanced Recovery in Orthopaedics GYNAE Live 2011 Live Oct. 2010 Live 1 Sep 2010 U’LOGY Live March 2011 Live Oct. 2010 COLO Live 2009 Live Sept. 2009 Live 5 July 2010 Planning 2012 MSK Live Oct. 2010 Live Sept. 2010 Live 2011 PHT UHSFT IOW Live Sept. 2010 No plans To be reviewed in 2012 Planning 2011/12 Live 1 Sept 2010 Live 2010 Planning 2011/12 Live Apr 2010 Live 2011 Live June 2011 Live April 2011 Live Jan 2010 Live May 2010 Live Oct. 2011 Live Sept. 2010 Live June 2011 Converted to ERP Live 1 Aug 2010 Live April 2010 OUH HWWP BHT Planning 2012 Planning Planning Planning 2011/12 2012 2011 2009 Live Nov. 2011 RBH WEHT BNHFT Innovation Innovation Site Site Reductions in Length of Stay Hip Replacements 2008/10 2011/12 YTD Provider name Mean LOS Mean LOS Variance Buckinghamshire Hosp NHS Trust 6.05 5.36 0.68 Heatherwood & Wexham Park FT 7.61 4.78 2.83 Portsmouth Hosp NHS Trust 7.80 5.29 2.52 Royal Berkshire NHS FT 6.51 4.83 1.68 Southampton Uni Hosp NHS Trust 8.24 6.40 1.84 Isle of Wight National Health Service 5.69 5.38 0.31 Winchester And Eastleigh Healthcare NHS Trust 8.46 5.15 3.31 Basingstoke And North Hampshire NHS Foundation Trust 5.54 3.94 1.59 Nuffield Orthopaedic Centre NHS Trust 6.83 5.81 1.02 South Central SHA 6.99 5.31 1.68 Knee Replacements 2008/10 2011/12 YTD Mean LOS Mean LOS Variance 5.48 4.90 0.58 6.78 4.84 1.94 7.79 5.66 2.13 6.18 5.25 0.93 7.87 6.95 0.92 6.14 4.92 1.22 8.46 4.99 3.47 7.81 6.01 1.81 6.71 5.58 1.13 6.99 5.49 1.50 Overall Reduction in LOS for Hip Replacements Overall Reduction in LOS for Knee Replacements Shared Decision Making/Decision Aids Activities•Pilots for OA knee- NOC and Solent •SDM/DA feature in many QIPP plan for 12/13 •Cluster team based event on SDM- local plans •Strong links with SE and SW colleagues •Significant interest in Train the Trainer courses Shared Decision Making & Decision Aids Next Steps • Set up community of interest – HIECs to support development • SHA progress region wide plan • Commission course to train the trainers – based on SW model links to self management programme • Follow-up cluster plans and support • Embed in hip & Knee MSK pathways • Support the development of future decision Decision Aids- next steps Brief decision Aids (BDAs)•Request from clinical colleagues in Newcastle to write and comment on BDAs •Designed for primary and specialist settings •Piloting in NE- popular with patients and clinicians •Partnership with EMIS- building on patient information leaflets (PIL)– to form basis of BDA •Have short list of topics to be covered •Seeking- authors to convert PIL to BDA, clinicians and patient to comment Procedures of Limited Clinical Value Activities•Promotion and use of Atlas of variation, no national list •Each PCT has a PLCV aspect to QIPP plan for 2011/12, all on target to deliver. •Most moving to a more comprehensive approach- re use of SDM/DA to support work PLCV- ? next steps • ? Alignment across South Central/Southern cluster • COBIC (Capitated and Outcome-Based Incentivised Contract) project- Oxford • Focus on SDM and DA’s- engagement with option grid development CLN – Future Discussion CLN- where to focus effort for maximum gain? •StarTBack- adoption across primary care •SDM/DA’s- embedding of tools and way of working in all MSK pathways, ?contribute to BDA development •A comprehensive pain service •Improving Quality programme orthopaedics interface •What else?