KEY COMPONENTS OF A CUTTING EDGE SUCCESSFUL MUSCULOSKELETAL INTERFACE SERVICE (MIS) IN THE UNITED KINGDOM (UK)

Nawoor S.¹, Menon A.¹, Emma H.¹, Morris A.¹, Stevenson K.¹, Dowson C.¹

¹Staffordshire and Stoke on Trent Partnership NHS Trust, Musculoskeletal Interface Service, Stoke on Trent, United Kingdom

Background: In the United Kingdom around 7.5 million working days are lost because of Musculoskeletal (MSK) conditions, second only to mental health (H&S Executive, 2012). Costs are estimated at £14.8 billion for Osteoarthritis and Rheumatoid Arthritis (Oxford Economics, 2010), with up to a further £10 billion of indirect costs attributable to back pain in the UK (Maniadakis et al, 2000). They are the most common reason for repeat consultations with Family Physicians (FP) (30%) (DoH, 2006). Healthcare purchasers in the UK (National Health Service) wanted to ensure MSK disorders were seen by 'the right person, with the right skills at the right time' (NHS England, 2014).

Purpose: To describe the development and components of a nationally recognised (MIS)

Methods: The MIS was commissioned by North Staffordshire Commissioning Groups in 2011 to:

Assess 90% of patients within 3 weeks of referral from FP or physiotherapists

Assess non inflammatory and non-serious (red flag pathologies)

Manage 70% of clinical case loads in primary care away from the hospital environment

Reduce Orthopaedic waiting times for operations (e.g.Total Hip and Knee Replacements)

Improve number of appropriate referrals into surgical teams

Create a multidisciplinary team culture
A Consultant Physiotherapist, Rheumatologists, Extended Scope Physiotherapists (ESP) and service management teams worked collaboratively to design clinical and professional frameworks to deliver key criteria’s.

Results: The MIS has consistently delivered against key criteria by creating an innovative, multidisciplinary evidence based services, which has:

Successfully managed an increase in annual referrals from 6,000 (2011) to 13,500 (2015)

Reduced waiting time for surgical opinion from 2 years to 18 weeks

Improved conversion rates to surgery i.e. patients seeing a surgeon receiving surgery (20% in 2005 to 70% in 2016)

Allowed 70% of patients to be managed in community clinics closer to home

Achieved over 95% patient satisfaction rates

Developed Multidisciplinary Team, (MDT) Clinical pathways, ensuring clinical consistency with key competencies for all, irrespective of profession

Undertaken peer reviewed research published based on service population

Been cited as an exemplar of good practice by Department of Health and Kings Fund

Ensured Extended ESP roles are at its core by providing 80% of all consultations

Created joint academic posts and evidence into practice groups

Supported ESPs training and development into injection therapy

Conclusion(s): This multidisciplinary model of Consultant Physiotherapy, ESPs, Medical and Operational leadership, administrative and IT support allows a specialist MIS to provide effective patient care. As part of this team ESPs deliver high level clinical reasoning as well as delivering Nerve blocks and Spinal epidurals.

Funding acknowledgements: The Musculoskeletal Interface Service is commissioned through North Staffordshire and Stoke on Trent Clinical Commissioning Groups

Topic: Musculoskeletal

Ethics approval: No ethical permission was required for this project

All authors, affiliations and abstracts have been published as submitted.