Mission Statement
A few words about the organisation
Pennine MSK Partnership is a Specialist Personal Medical Services partnership that has been commissioned by Oldham PCT to provide a comprehensive service to the population of Oldham in Rheumatology, Orthopaedics and Chronic Pain.
It started on 1st March 2006, but was developed from a "Tier 2" service in Rheumatology that has run successfully since January 2004. The Tier 2 service was designed to screen GP referrals into secondary care, managing those patients who did not need to see a consultant rheumatologist and ensuring those patients referred on to secondary care were fully investigated before seeing the consultant. The service was managed by the PCT and clinically lead by Dr Alan Nye (GPSI Rheumatology) and Anne Browne (Nurse Consultant Rheumatology) with input from specialist physiotherapy, liaison psychiatry and osteoporosis nurse specialist. The Tier 2 service was highly successful with 70% diversion of GP referrals away from secondary care, with high levels of patient, staff and GP satisfaction.
The development of the Tier 2 service into an ICATS was jointly driven by Oldham PCT Modernisation department and the Tier 2 clinical team. The primary differences between Tier 2 and an ICATS in design and delivery is:
- To cover a wider clinical fields rather than just rheumatology.
- To unify and simplify patient pathways for a whole range of clinical conditions.
- To improve the patient journey, shortening waiting times for assessment, treatment and investigation.
- To provide better value for money for Oldham PCT.
- To allow the clinicians to design and deliver the service rather than managers, in particular the SPMS partners have a direct financial interest in the success of the service.
- To allow effect local practice based commissioning across MSK medicine by close co-operation between GP commissioners and the SPMS partners.
- To deliver the 18 week patient journey in MSK
There are three partners, Dr Alan Nye, Dr Hugh Sturgess and Mrs Anne Browne, a full time administrator and three administrative staff. We directly employ the osteoporosis nurse and a specialist physiotherapist (upper limb); all other staff are either seconded or employed on a SLA, either privately or with their employing authority. We work very closely with our hospital consultant colleagues. We are a paperless service and use electronic patient records. After referral patients are triaged and then offered an appointment with the most appropriate clinician based on the GPs referral letter.
Aims
In 2004, the NHS issued the 10 High Impact Changes. The Pennine MSK ICATS is ideally placed to meet many of these challenges:
- We always treat wherever clinically possible new patients as "See and Treat" and operate a one stop service for our patients. So far approximately 40% of new patient referrals are treated in this way.
- We will have access to the IS procurement for diagnostic tests in Greater Manchester. This will bring waits for many key diagnostic tests down to days rather than months.
- We avoid patient follow up appointment unless there are clear clinical grounds for them. We also offer telephone follow-up and patient initiated follow-up (self referral) for those patients with chronic conditions so patients are only seen when there is a clinical need.
- We plan by the end of our first year to have taken over the care of chronic rheumatological disease. The pathways will be redesigned by our consultant rheumatologist to improve patient care and to ensure the service is truly patient centred and to avoid unnecessary hospital admissions.
- We closely monitor the flow of patients through the entire ICATS, so we can identify and remedy any bottlenecks. The electronic record allows weekly monitoring of all patients waiting for new, follow-up or any investigation or treatment. We have a highly flexible service with staff being able to cross cover so bottlenecks are not allowed to develop.
- We encourage all staff to take on an enhanced role and personal development plans for staff are regularly reviewed
Monitoring activity with the 18-week patient journey has not been a problem for our service because of our use of electronic patient records. Currently new patients are triaged in 24 hours, have a 1-3 week wait for an assessment appointment and if a follow-up appointment is needed this is usually in a further 2-3 weeks. The vast majority of patients are seen and discharged from the service within 7 weeks of referral.
Our SLA with the PCT requires us to provide a patient centred service, with rapid assessment and discharge of patients. We also provide a service from several different locations across Oldham ensuring ease of access, and some evening appointments are offered.
Service Design and Development
We are totally funded by Payment by Results. We ensure value for money for the PCT by offering a 10% reduction on national tariff. We are able to offer this reduction by having a lean management structure. We have one full time administrator and three secretaries, but this is a service run and developed by clinicians.
When the ICATS started on 1st March 2006, it just covered all new rheumatology and osteoporosis referrals. Three months ago we launched and new foot and ankle pathway that is run by 2 podiatrists. A consultant surgeon will be working sessions in this service by November. We have also set up a hand service for trigger fingers, carpal tunnels and hand osteo-arthritis. This again will be multidisciplinary using physiotherapists, occupational therapist as well as sessions from a consultant plastic surgeon. On 1st October we took over the existing tier 2 orthopaedic service and we now offer a comprehensive musculoskeletal assessment service. We have 5 local orthopaedic surgeons who will be working with us over the next few weeks.
Over the next year our SLA requires us to develop a combined chronic pain and psychological medicine service. We also plan to be able to offer day surgery within the ICATS, so increasing patient choice and speeding the patient journey. We are also interesting in consultants becoming partners in the ICATS so breaking down the division between primary and secondary care.