Delivering integrated Musculoskeletal services in the community
Why change was needed
Musculoskeletal (MSK) services, which treat conditions which affect the joints, bones and muscles, as well as include rarer autoimmune diseases and back pain, place a high demand on primary, community and hospital services. It is estimated that they make up 20% of all GP appointments and the demand is growing as the population ages. About 30% of people referred to hospital to see a specialist come away with no outcome and are often discharged back to their GP. This is not a good experience for patients or the NHS.
We knew that this model in Coventry was not meeting the needs of people affected by MSK issues and was not sustainable in the face of growing demand on local NHS services.
What we did
Many musculoskeletal problems are long term conditions that require comprehensive care and pain management support from a variety of health professionals and across a range of services. To address this, partners from across Coventry Place including University Hospitals Coventry and Warwickshire NHS Trust and Coventry and Warwickshire Partnership NHS Trust, worked collaboratively with the Integrated Care Board and Primary Care Networks to design a new model for care.
Together they have developed an “integrated pathway” which brings care together for patients from all different services. Patients have access to a number of healthcare professionals, including physiotherapists, in order to provide the best possible health and wellbeing outcomes. This enables patients to receive the right care, at the right time in the right place, focusing on delivering services in local communities and with a greater emphasis on prevention, self-management and holistic therapy-led treatments instead of hospital-based care.
The service will support people at all points on the pathway, starting with prevention of MSK conditions through promotion of healthy lifestyle approaches. Patients can be referred to a team of specialists from different areas to receive the most appropriate and comprehensive support rather being sent to hospital as a first option.
Phase 1 of the programme focused on streamlining the way patients access services. Under the old model, patients with MSK concerns were referred by their GP to hospital to see a specialist. If they did not require hospital services but could be treated in the community they had to go back to their GP who would then make a new referral to community services.
The new model allows patients to see a First Contact Practitioner (FCPs), a specialist physio who can access diagnostics and provide specialist assessment, at a local GP practice. These patients are assessed through a new Multi-Disciplinary Team (MDT) for MSK triage, made up of experts from different specialities. This team can then refer the patient on to physiotherapy, Trauma & Orthopaedics, rheumatology and spinal services.
This means that patients who would benefit from physiotherapy or similar treatments can be redirected to the correct service directly by the triage team rather than being passed back to their GP to make a new referral, shortening the process and improving their experience. The team includes physiotherapists, GPs and secondary care consultants to provide an integrated and multidisciplinary referral management service for Coventry.
Pilot clinics to test the model, led by First Contact Practitioners, took place in a number of GP practices in Coventry. Following successful evaluation, including positive feedback from patients, a team of senior physiotherapists have now been deployed and clinics have now gone live in 19 GP Practices across Coventry. To support the programme we also appointed a Consultant Physiotherapist – a first for Coventry – in order to provide clinical leadership, clinical expertise and R&D. This programme has also enabled us to invest in our physiotherapy workforce by improving the skills of our existing staff.
Phase 2 of the programme will focus on prevention, self management and supporting people to engage in healthy lifestyle behaviours. Following the success of this pilot we also will be using the FCP model to address backlog of patients in Trauma and Orthopaedics.
“The vision of the pathway is simply to provide the right care to the right person in a timely manner and appropriate location. Currently a large proportion of referrals to secondary care could have been managed more effectively at an earlier point along the pathway by allied health professionals without the requirement for referral to secondary care. I’m also really keen that we ensure that the people using our services, the service providers and all of our partners are involved so we achieve the ultimate goal which is to provide high value care for the people of Coventry. In the future I would like to see Coventry recognised nationally as a being a centre of excellence for musculoskeletal care.” Dr Christopher Newton, Consultant Physiotherapist at UHCW
“It has been a really good experience working in GP practices as part of the FCP Pilot. The feedback we had from patients has been positive and the majority found it really useful to be able to access MSK advice / education at the first point of contact at the GP practice." Kelly Turner, Clinical Specialist Physiotherapist at CWPT
MSK conditions are very common, affecting over £20 million people in the UK. Often these can be treated at home without a trip to a GP or hospital. A new resource has been launched for people experiencing muscle and joint aches and pains prior to them seeking healthcare and during/after healthcare consultations. The MSK self care guides can be found here: Self Care - University Hospitals Coventry & Warwickshire (uhcw.nhs.uk) – and can be translated into a number of different languages.
The mains reasons for designing these guides were:
- They can have a significant impact on the individual and their quality of life including work.
- Little is known about them (amongst the general public and amongst colleagues in healthcare).
- Often they can be self-managed, but it is useful for people to know if and/ or when and where to seek healthcare.
- This information may also help to reduce some pressure on already stretched services across our Health and care and social systems.