Transformation of MSK services in Halton Cheshire to First Contact Practitioner

Purpose

To describe the transformation process undertaken over two and half years and share our experience of the redesign in both terms of success and challenges.

£500,000 saved in the first 6 months
through reduction in investigations, injections and secondary care referrals.

Approach

We began with service user engagement events to understand the issues with the existing MSK service. From these, smaller working parties of clinicians which consisted of a secondary care consultant, GP, physiotherapists from MSKCATS and AQP providers began to look at alternate models for MSK delivery including first contact practitioner model. A 3-month pilot in one of the GP practices evaluated the impact of MSK first contact practitioner posts. The pilot was in collaboration with the service provider of MSKCATS (Warrington and Halton Trust) and an AQP provider. Both patient and GP feedback evaluated the pilot.

A formal submission to change to first contact practitioner model instead of the interface model was made to Halton CCG through the correct committees and was granted in May 2016. Pump prime investment was approved for £250,000 to increase staffing levels.

The service went live in April 2017, provided by Warrington and Halton FT. Over the year, the service has collated KPI data on referral rates, DNA rates, cost saving and patient satisfaction and has underwent several iterations to continually deal with the increasing demand.

Outcomes

In the first 6 months, the conversion rate into surgery has maintained at 80%: the same as when it was an interface service. The FCP model has reduced waiting times for an MSKCATS assessment. In the interface model patients waited 11 weeks to be seen by an MSKCATS practitioner but in the new FCP model, patients initially undergo a telephone consultation (currently 4 week wait) and if needed, a face to face assessment is arranged within 2 weeks, making it a 6 week wait.

Physiotherapy waiting times have reduced from 17 weeks to 8 weeks due to the reduction in referrals from MSKCATS and GPs. MSKCATS are helping patients self-manage their conditions. Friends and Family tests are consistently 5/5.

Cost and savings

In the first six months, MSKCATS has saved £500,000 through reduction in investigations, injections and secondary care referrals.

Implications

A first contact practitioner model saves money, reduces unnecessary investigations and referrals into secondary care, whilst still maintaining a high conversion rate into surgery and increasing the RTT time secondary care has to 18 weeks. It has an impact on physiotherapy waiting times and provides patients with self-management advice and education quicker than in previous pathway. It provides a service with high patient satisfaction feedback.

The FCP model has potential for wider implementation in Primary care leading to greater efficiency in managing patients who have an MSK conditions. Our service data will aid other services in redesigning to FCP model and also help provide national evidence on the impact of these services. Increased funding may need to be secured initially to aid services in implementation of FCP.

Top three learning points

1. Transformation takes time and needs collaboration and buy in from services and CCG alike

2. Physiotherapists as first contact practitioner can make a massive impact in MSK pathway

3. Keep looking for improvements and constantly adapt to the needs of the service

Fund acknowledgements

Funding was provided in terms of pump prime investment of £250,000.

Additional notes

This work was presented at Physiotherapy UK 2018.

The author can be contacted for more information: lisa.horne1@nhs.net