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?