- The Clinical Commissioning Group was looking to reduce waiting times substantially, reduce inappropriate referrals, drive down imaging costs and improve patient outcomes substantially through one single integrated service.
- Running a full procurement process they were seeking to transform the service from a patient and quality perspective whilst drastically improving value delivered to the NHS.
What We Did
- We took two sets of transferred staff, added 10% of our own expert clinicians, revised the pathways and deployed new technology and ways of working while injecting zest and pace through dynamic management and leadership.
- Working closely with GP and Patient Groups we re-configured the service, focussed on what is evidenced to work and invested heavily in staff communication, training and development to integrate a team to a new vision of MSK services.
- Wait times halved in the first 90 days, DNAs halved, Patient Outcomes improved significantly, imaging costs reduced dramatically to appropriate levels with wide recognition of a transformation in progress from all stakeholders.
- Longer term benefits include reduced re-referrals from improved pathways and the ‘Whole System’ benefits being enjoyed by Acute Partners.
Pathway Transformation and
Single Point of Access
- Within the CCG there were historically high levels of referral to acute Orthopaedic services. This presented a significant challenge to the CCG for achievement of QIPP savings and for access and demand issues at the acute hospital with poor rates of conversion to surgery. The locality presented its own challenges demographically with an age profile generating high Orthopaedic demand. The challenge was to design a new pathway to sustainably reduce and improve the use of acute Orthopaedic services and manage an improved community offering.
What We Did
- We developed, presented and gained approval to pilot a new model of care for the CCG. This not only provided a high-level clinical triage of all referrals through a single point of access, agreed with the GP cohort, but also specialist intermediate clinics as a one-stop-shop. These included Point of Care Ultrasound, reducing the reliance on MRI, and offered surgical and rehabilitation advice with treatment at one appointment. Combined with an active, activity-based community rehabilitation programme this promoted the completion of the maximum episodes of care in the community setting.
- Working closely with the acute teams we managed surgical thresholds and demand in a sustainable way.
- Referrals to secondary care Orthopaedic services over the first 6 months, within our trial area, were reduced by 80%, with a QUIPP saving over 6 months of £1.1m.
- Conversion to surgery for those referred improved significantly, with patient satisfaction ratings in excess of 94%.
- The service has now been extended and we look forward to continue working with the Commissioners on the long term sustainability and new contracting formulae.
- Attract and retain specialist clinicians in a challenging recruitment and retention environment
- Develop multi-skilled clinicians that allows the delivery of tomorrows healthcare today
What we did
- Partnered with universities to offer in post clinical mentoring and supervision in the specialist areas of Pointy of Care MSK Sonography, Non-medical prescribing and Sports and Exercise Medicine
- Offered Healthshare Employment and Fellowship Training Programmes that covered both funding and supervision expenses leading to specialist accreditation within 18 months
- 7 senior physiotherapists trained in sonography to deliver further benefits in our services
- 3 senior clinicians trained as independent prescribers to deliver benefits to patients
- All clinical staff undergoing psychological skills training to enhance our rehabilitation support for patients
- Our Sports and Exercise therapists are developed under a new Healthshare competency framework to support our patients with a holistic approach to their care
Primary Care Home
(Care Delivery at Scale)
- Aware of the direction of travel towards accountable care in health commissioning, a GP group in one of our service localities was keen to form an independent PCH to deliver out of hospital services to their combined population, with a view to future MCP transition. Our work in service transformation, innovation and delivery locally led them to approach us to partner them in management and ownership of the PCH. The challenge was to build, coordinate and mobilise an independent Primary Care ‘at scale’ organisation, delivering on 18 ‘out of hospital’ care contracts.
What we did
- We created and agreed a new, collaborative corporate structure and developed governance arrangements reflecting the requirement for collective, population-based healthcare.
- We designed and operated a new Single Point of Access triage to update and streamline the administration, reduce unwarranted variation of care and ensure equality of access and service coverage.
- A safe, efficient and collaborative organisation delivering joined up and accessible community care to a population of 60,000 people. Established a proof of concept locally for the delivery of Primary Care Home, at scale working.
Primary Care Front Line Practitioners
- Reduce the number of Orthopaedic, Rheumatology and Pain Management referrals being made to secondary care providers from primary care
- Increase GP appointment capacity by 25% by offering MSK consultations via Front Line Practitioners
- Upskill local GP and Nurse Practitioners in MSK, Orthopaedic and Rheumatology
What we did
- Identified with the CCG and GP Federations primary care practices with outlier referrals rates, in need of MSK upskilling and where staff shortages were evident
- Consult with practices on the benefits of Primary Care Front Line Practitioners (PCFLP) and agree work remit
- Positioned experienced PCFLP’s with non-medical independent prescribing qualifications into practices where need was apparent
- Patients see a specialist at first contact improving outcomes for them
- Reduces unnecessary secondary care referrals and imaging referrals thereby saving the NHS money
- GPs see significant reductions in workload around MSK conditions
- GPs are upskilled in MSK competencies
- The Clinical Commissioning Group was under extreme QIPP pressure to find improvements and savings in a seemingly never ending expansion of activity, diagnostic spend and cost for MSK and Orthopaedic activity.
- Coupled with their Acute Providers under increasing treatment wait time breaches they asked us if Healthshare could help.
What We Did
- We worked with the Finance, Contracting and Business Intelligence leaders in the CCG to present a proposal to the Commissioning Leadership and NHS England. This was accepted and contracted.
- We implemented a Single Point of Access with a mutual sharing of risk and gain that incentivised Healthshare to make real savings in the whole patient pathway.
- We worked closely with GPs, Acute Providers and Diagnostic Providers to refer, triage and treat equitably across the MSK pathway. We invested in senior clinical resources at the referral and triage stage implemented through our researched and proven algorithms.
- Healthshare invested heavily in joint working with Primary, Community and Secondary Care.
- Reduced whole pathway costs and accelerated access to the most appropriate level of care for patients. Improved quality of acute referral and significantly reduced diagnostic spend.
- A real working relationship across Primary, Community and Secondary Care has been developed that will provide further benefits for the NHS.