What services are included in the new integrated MSK service?

Alongside multidisciplinary triage, diagnostics and assessment for MSK conditions, the new service will include the following specialities for all patients aged 16 years and over:

  • Orthopaedics (not trauma)
  • Physiotherapy
  • Pain management
  • Rheumatology
  • Orthotics
  • Podiatry (non diabetic podiatry)

Why did CCGs need to procure a new integrated service?

Whilst many patients currently experience excellent MSK care, some patients were experiencing problems which CCGs were keen to address. They included:

  • Widespread variation in the ways GPs are referring patients for example two patients with the same conditions could be referred in different ways.
  • Some patients are experiencing fragmented services.
  • Patients may experience repetition during their MSK journey – for example having to relay their story and symptoms repeatedly.
  • There is a duplication of services being offered.
  • Some services are only available to patients living in certain parts of the area e.g. clinical Assessment and treatment services at the Apollo in Eastbourne.
  • There are currently multiple providers.
  • Treatment options offered to patients may be dependent on the professional the patient sees.
  • As a CCG we spend more than we would expect to for the size of our population on MSK service compared to other areas, even when you have taken factors such as local demographics into consideration.

CCGs wanted to take the opportunity to review the treatment that patients currently received and procure a new service to ensure our patients get the care and treatment they need in a timely and cost effective manner.

What are the benefits of the new integrated service?

There are numerous benefits including:

  • Treating more patients in community based settings.
  • Providing patients with quicker and more equitable access to specialist advice, diagnostics treatment and rehabilitation.
  • Offering patients a one stop shop of assessment and on-going care.
  • Providing better coordination of follow up care between providers, patients and GPs.
  • Reinforcing shared decision making opportunities for all referred patients.
  • Offering patients a single point of access when they are discharged from secondary care.
  • Providing better coordination of rehabilitation that enables patients to be supported in their own homes.

Who made the procurement decision?

CCGs began the procurement process back in 2013 when they took time to understand patients and local clinician’s experiences of existing services. Discussions were then had with existing and prospective providers. The procurement process itself was a robust and transparent process that included effective patient representation during the evaluation stage when bids from providers were received and analysed. The final decision was made by the CCGs Governing Bodies which includes local GPs, other clinicians and lay members representing patients and the public.

How have GPs been involved in the development of the new service?

CCG clinical leads have been working closely with local GPs through protected learning time events and localities meetings to understand their requirements for the service and ensure their feedback, experience and ideas could be incorporated into the design of the new service.

GP engagement will continue both in the run up to and after the launch of the new service and local clinicians can contact clinical leads at any time.

A key aspect of the new service is shared decision making – isn’t this already a part of the conversation GPs have with patients?

Many GPs are already offering patients the opportunity to have a say in their care (shared decision making). We also know that only a small proportion or patients currently have access to a part integrated service and we want to make this available to all patients equitably.

CCGs are committed to ensuring services better involve patients in decisions about their care and treatment. With greater involvement in decisions about their care and treatment patients will be able to far more informed choices and thereby achieving better outcomes in terms of expectations and experience.

How will the service be monitored and reviewed?

CCGs have a responsibility for ensure any commissioned is high quality, safe, deliver what patients expect and meeting the needs of local people. CCGs will constantly review and monitor the services against a specific set of key performance indicators which include areas such as accessibility of services, patient experience, waiting times and clinical outcomes. The service will also be held to account using national quality outcome measures and patient reported outcomes to ensure innovation and service improvement are considered throughout the service duration. If we identify any areas where providers are not meeting the high standards and expectations we expect for our patients there are clear processes in place to rectify this.

How does patient choice occur when everyone has to go through triage anyway?

A key aspect of the new integrated service is to reinforce patients having more say and control of their care including choice over their treatment where possible. The multidisciplinary approach will mean patients have more information about a range of treatment options and can make an informed choice that is likely to achieving better outcomes as their expectations and experience are appropriately managed. Patients will still be able to choose their secondary care provider for surgery.

How can GPs exert choice? Can I refer to particular clinical areas within the hub?

All patients (excluding red flags) will be referred to the service and receive a clinical paper triage which will direct the referral to the element of the service required to meet that patient’s clinical need. Therefore if the patient requires an assessment by a Multidisciplinary Orthopaedic Team that is what they will receive, alternatively if the patient only requires a consultation with a Rheumatology Consultant that is what they will receive.

What is the impact of the new service on existing providers/ hospitals? How will clinicians from other service providers be involved?

CCGs conducted a robust and transparent procurement process to determine the right provider to deliver support for patients locally. Sussex MSK Partnership’s approach is to draw together existing local providers of services including existing NHS trusts and other independent who all have extensive and demonstrable experience of delivering high quality services. Sussex MSK Partnership has key agreements in place with local NHS trusts to ensure patient’s experience seamless care when they require treatment from a particular provider. GPs will continue to be provided with better communications about their patients care.

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