NHS Southport and Formby Clinical Commissioning Group (CCG) and NHS West Lancashire CCG saw an opportunity to reduce waiting times for orthopaedic services and save around £3m in a year.
The problem
In 2016, routine waiting times for orthopaedic services in Southport and Formby were 10 weeks, while West Lancashire CCG had a waiting list for physiotherapy services of up to 26 weeks.
Given that the area has a higher than average population of older residents, with increasing rates of orthopaedic conditions, action was required to improve patient experience and outcomes.
In addition, a fragmented pathway was leading to clinical and operational inefficiencies, resulting in excessive costs being incurred by the local NHS.
The solution
Southport and Formby CCG, West Lancashire CCG and Southport and Ormskirk Hospital NHS Trust worked in partnership to develop a new service, the Joint Health – Integrated Musculoskeletal (MSK) Care.
The service provides a single point of access to a specialist assessment and treatment service for orthopaedic conditions to ensure patients see the right clinician at the right time.
It is achieved by combining both routine MSK physiotherapy services and musculoskeletal clinical assessment services (MCAS).
During the redesign, we worked in collaboration to design new pathways with primary care clinicians and introduced self-referral, currently piloted by West Lancashire, which reduced the need for patients to see their GP before accessing the service.
We developed an online patient resource to promote and support self-management called Physitrak. We also employed sports exercise medicine consultants and a consultant physiotherapist to improve the expertise available to the service.
The results
Joint Health has delivered everything it was designed to achieve, with improvements in clinical and operational efficiency and significant cost savings for the local NHS.
It has delivered a 20% reduction in secondary care orthopaedic activity and an increase in the orthopaedic surgical intervention rate from 51% pre redesign to 78% post implementation.
These changes have delivered savings of £757,000 for Southport and Formby CCG so far.
As of 8 November 2017, £755,000 has been saved in West Lancashire.
Our teams are forecasting a full year saving of £1.8m for Southport and Formby CCG and £1.21m for West Lancashire CCG.
These significant savings are allowing the CCGs to achieve greater value for money.
The service redesign has also embedded improvements in patient experience and health outcomes by ensuring that patients have access to specialist conservative treatment before embarking on surgical interventions, where appropriate.
Additional benefits to patient experience include the provision of physiotherapy services closer to home and regular educational programmes for primary care clinicians.
Joint Health has also improved resilience in local primary care services and we have found that local GPs supported the single point of access for orthopaedic referrals, due to the improvements in waiting times and clarity of service delivery.
The future
Despite some financial challenges associated with implementing the redesign, work is progressing with South Sefton CCG and its MCAS provider, Aintree University Hospital NHS Foundation Trust, to implement a similar model.
CCG comment
‘The success of Joint Health has already been picked up by neighbouring CCGs and other NHS organisations interested in replicating elements of the service.
‘It is a major piece of transformational work requiring both CCG and provider to have an honest, open and transparent relationship, sharing knowledge of areas requiring improvement as well as opportunities to deliver the service better in the future.’
Jan Leonard is the chief redesign and commissioning officer of Southport & Formby CCG
