: Service Specification SCHEDULE 2 - THE SERVICES SERVICE SPECIFICATION Service Commissioner Lead Provider Lead Musculoskeletal Clinical Assessment Service Physiotherapy Service NHS Knowsley 5BP NHS Foundation Trust Therese Patten/Sue McGuire 1. Purpose 1.1 Aims To deliver rapid access and streamlined care for patients with musculoskeletal pathology. Service is governed by local targets agreed with the commissioners. Service changes are driven by various national political drivers including the 18 week patient pathway, musculoskeletal services framework and white paper Our Health, Our Care, Our Say 1.2 Evidence Base Musculoskeletal disorders have a significant social and economic impact. Data from the Health and Safety Executive indicate that in 2006/07 1,144,000 people in Great Britain suffered from a musculoskeletal disorder caused or made worse by their current or past work equating to 2.7% of people who have ever worked in Great Britain. Data from the Labour Force survey over the last 5 years indicated that on average 10 million days were lost due to musculoskeletal disorders every year, second only to stress, depression and anxiety. The average annual days lost per case in 2006/7 was 16.7 days with 0.46 days lost per worker. In the UK, it is estimated that the total cost to the nation of musculoskeletal disorders is 5.7 billion, annually. There are more than 200 musculoskeletal conditions affecting the population including all forms of arthritis, back pain and osteoporosis, some of which can result in long term functional disability. It is estimated that up to 30% of all GP consultations are regarding musculoskeletal disorders. It is recognised that the ageing population will continue to further increase the demand for age related disorders such as osteoarthritis and osteoporosis The Musculoskeletal Services Framework (MSF) is the Government s strategy for long-term conditions, which includes Supporting people with long-term conditions: Improving care, improving lives and the National Service Framework for long-term conditions. The overall vision is that people with musculoskeletal conditions can access high-quality, effective and timely advice, assessment diagnosis and treatment to enable them to fulfil their optimum health potential and remain independent. The Our Heath, Our Care, Our Say white paper also suggests patients should have real choice and greater access to health and social care, with services being delivered safely and effectively in the community or closer to home. 1.2 General Overview
In line with NICE guidelines/ Evidence based practice the service will provide: Physiotherapy assessment and therapeutic interventions based on individual patient need. This may be group or individual therapy dependent upon both presenting condition and patient need. Individual patient care plans, which address contributory factors such as lifestyle factors, behaviour change, education and physical activity. Referral to other services e.g. AMP triage service for opinion were appropriate 1.4 Objectives Evidence based care with clinical pathways and protocols to support service delivery and high quality patient care for patients with musculoskeletal pathology Patient centred service with patient involvement and choice at each stage of the patients journey Integrated multi-professional working to facilitate patient management Rapid access service with minimal sequential waits between services Geographically easy to access service. 1.5 Expected Outcomes The desired outcome for each person shall be defined in their individual goal setting following assessment and by the outcome measures. The Service Provider however shall ensure that the service: Meets the assessed / identified needs of the Service Users and fulfils the objectives set out in their support plans. Demonstrates a reduction in the referral rate from primary to secondary care Demonstrates high level of patient satisfaction with the service Promotes development of self management strategies and healthy lifestyles 2. Scope 2.1 Service Description The Musculoskeletal Clinical Assessment Service (MCAS) is a multi-professional primary care based service which assesses and manages patients with musculoskeletal pathology in primary care and also directs referrals to secondary care if required. The overall result is a rapid access, streamlined service for all patients with musculoskeletal pathology. Currently, physiotherapists, Advanced Musculoskeletal Practitioners (AMP s), podiatrists and health care assistants are involved in the provision of care. AMP s are physiotherapists who have advanced specialist training in musculoskeletal pathology including requesting of relevant investigations such as blood tests and MRI scans. Patients referred will be either managed in primary care and discharged following appropriate treatment or referred on to secondary care by agreed referral protocol. The AMP s are involved in spinal, upper limb and lower limb specialist physiotherapy clinics and will assess and manage patients referred from both physiotherapists and general practitioners. This is normally indicated for patients who require further assessment and investigations (imaging or blood tests) prior to referral to secondary care and / or who have failed routine physiotherapy. 2.2 Accessibility/acceptability The delivery of MCAS in the community provides choice and access for the adult patient population.
All venues are accessible and compliant with Disability Discrimination Act legislation. The service provides comprehensive services for people from 16 years upwards. Issues related to age, gender, sexuality, culture and disability are dealt with appropriately and sensitively. Where language/cultural issues are evident, the appropriate external resources are mobilised, e.g. Language Line. The service operates within organisational policies which are Impact Assessed to ensure equality and diversity issues are highlighted and monitored. The values that underpin MCAS are: Respect the dignity, privacy, confidentiality and cultural diversity of all developing an open and supportive organisation. Champion vulnerable people through equity, fairness and the integration of health and social care. Be a good employer, demonstrating our commitment to staff development, involving and engaging the workforce and striving to make Knowsley a place where people want to live and work. Play an active part in the development of the whole community, ensuring that we are approachable, accountable and inclusive of all members of that community. MCAS will ensure compliance with Knowsley Safeguarding Adults and Children s procedures. Care Providers need to: assess any risks of abuse whenever they are undertaking care planning or reviews with individuals promote access to advocates or other external agencies, including when care plans are reviewed ensure that their policies on safeguarding people align with the local council policies ensure managers and staff understand policies on safeguarding and whistle-blowing co-operate with investigations of abuse have a clear recruitment staff procedure which is always followed and includes adequate preemployment checks in line with the regulations take appropriate action to protect people where staff are alleged to have perpetrated abuse, including use of disciplinary processes and POVA list ensure staff are trained on how to safeguard people and that this is reinforced through team meetings and supervision. 2.3 Whole System Relationships It is anticipated that the agencies with whom the Provider is likely to develop close working relationships to attain optimum outcomes may include: Secondary care orthopaedic, rheumatology and neurosurgery teams Secondary care pain clinic Pain management/psychology services Accident and emergency Radiology/pathology departments Podiatry Out patient clinic nurses and administration staff Public and patient engagement This list is not exhaustive 2.4 Interdependencies Advanced Musculoskeletal Practitioner triage service
2.5 Relevant Clinical Networks and Screening Programmes Annual clinical pathway review agreed across the multidisciplinary team MSK networks to implement the NSF s Essence of Care (Knowsley Integrated Provider Services) Knowsley Integrated Clinical Governance 2.6 Sub-contractors None 3. Service Delivery Service Model Referral received paper or fax Referral triggered by AMP within 1 working day Requires acute consideration Require routine physiotherapy treatment Routine 1 st Appointment within 8 weeks Require specialist AMP assessment Routine 1 st Appointment within 3 weeks Start of 1 st Treatment Patient requires physiotherapy Patient requires imaging/ pathology Patient fails to respond Patient reviewed Start of 1 st within Patient improves Treatment 1 week of Discharge Patient improves Patient fails to respond Discharge Decision made to refer to secondary care 3.2 Pathways Clinical pathways are in place for all common musculoskeletal conditions. These are reviewed annually and updated in line with evidence based practice. In addition clinical guidelines from the Chartered Society of Physiotherapy are in place. 4. Referral, Access and Acceptance Criteria 4.1 Geographic coverage/boundaries The service will be provided to patients registered with a Knowsley CCG GP 4.2 Location(s) of Service Delivery Services are provided within the locations detailed below. Session times and allocation vary according to service needs.
Whiston hospital Huyton Primary Care Resource Centre, Nutgrove Villa, Huyton Whiston Primary Care Resource Centre, Whiston North Huyton Primary Care Resource Centre, Woolfall Heath Ave, Huyton Halewood Health Centre, Roseheath Drive, Halewood Bluebell Lane Primary Care Centre, Huyton Longview Drive Primary Care Centre Manor Farm Primary Care resource Centre, Huyton. 4.3 Days/Hours of operation Working hours and session number vary within bases according to service need. Hours of work are generally 8.00-6.30 Monday - Friday 4.4 Referral criteria & sources Referrals are received from primary and secondary care practitioners via a written referral using a standard proforma to allow appropriate triage of referrals. Patients may also self refer via a patient self referral form. Referrals are accepted for any patient over the age of 16 with musculoskeletal pathology excluding patients with back and neck pain covered under the separate AQP specification. 4.5 Referral route All referrals received into the MCAS service will be triaged by an advanced musculoskeletal practitioner to determine the health care professional and clinic most appropriate to their needs. Once triaged they will be seen within as either an urgent or routine physiotherapy appointment. Patients may be escalated into an advanced practitioner clinic for a second opinion if they fail to responds to treatment as anticipated. All patients are sent a partial booking letter following triage to contact the first appointments booking service to make an appointment at a location and time convenient to the patient. 4.6 Exclusion Criteria Patients with obvious red flags who require an urgent secondary care Consultant opinion to Rheumatology or Orthopaedics 4.7 Response time and prioritisation The following response times relate to the optimum staffing establishment Urgent All urgent musculoskeletal referrals will be seen within 4 weeks from the date the referral was received or earlier at the discretion of the triaging therapist. Routine All routine musculoskeletal referrals will be seen within 8 weeks from the date the referral was
received. 5. Discharge Criteria & Planning The service will discharge patients when: a) The patient fails to contact the booking service following receipt of a partial booking letter and a reminder letter to inform them to contact b) The referred patient fails to attend an appointment and does not re-contact the service within 2 weeks c) Patients who DNA 2 appointments are automatically discharged d) the referred patient completes care plan or is referred to another service 6. Self-Care and Patient and Carer Information Patient information is provided from both locally produced information in line with NHS guidelines and from commercially available information e.g. Arthritis Research Council leaflets. Information is provided as required for both administrative procedures and clinical information. 7. Quality and Performance Indicators HCAI Control Service User Experience Quality and Performance Indicator(s) Threshold 95% of patients satisfied or very satisfied with service Method of Measurement Via patient satisfaction survey annually. Quarterly focus group meetings with service users Consequ ence of Breach Reducing Inequalities 95% of patients satisfied or very satisfied with service Via patient satisfaction survey annually. Quarterly focus group meetings with service users Reducing Barriers Improving Productivity DNA rate does not exceed 10% Monitored monthly via performance management report Access 100% of patients Monitored monthly Increase d wait times for service users
are offered choice of location and appointment time via performance management report/ audit Personalised Care Planning 100% of patients offered choice of secondary care provider at the point of referral from primary to secondary care services 100% of patients have a documented treatment plan and agreed personalised goals Documentation audit bi-annually Outcomes New patient attendances within 5% tolerance level Waiting times within 10% tolerance of 8 week target DNA rate as previously Measured via monthly performance management report and regular commissioner meetings Additional Measures for Block Contracts:- Staff turnover rates Sickness levels Agency and bank spend Contacts per FTE 8. Activity Activity Performance Indicators Threshold Method of measureme nt Number of new patients seen 5% tolerance level of agreed target Monthly reporting Consequence of breach Increased wait times Risk to 18 week patient pathway
DNA rate Below 10% Monthly reporting Waiting times 8 week maximum wait Monthly reporting Activity Plan See Activity Plan in main contract for 13/14 Reduced efficiency due to slot wastage Increased wait times for patients Increased wait time 9. Continual Service Improvement Plan 10. Prices & Costs