Musculoskeletal services in Ealing 2013: Care closer to home

Abstract

Community musculoskeletal services in Ealing are organized with an integrated care approach, with most patients being managed in primary care and community settings, while, at the same time, providing clear and fast routes to secondary care. This is both clinically effective and cost-effective, reserving hospital referral for patients most likely to need surgery. Ealing Clinical Commissioning Group (CCG) implemented a ‘See and Treat’ interface clinic model to improve surgical conversion rates, reduce unnecessary hospital referrals, and provide community treatment more efficiently than a triage model. A high-profile general practitioner (GP) education programme enabled GPs to triage in their practices and manage patients without referral. The integrated care approach was implemented incrementally in three phases between 2005 and 2013, with a fourth phase planned for 2015. In Phase 3, only patients triaged by GPs to hospital outpatients are triaged by a referral management service, serviced by senior clinicians from the community musculoskeletal service. This secondary triage accounts for 15% of total GP referrals. The remainder being booked directly with no further triage beyond the initial GP triage unless marked ‘urgent’.

Keywords:

• Commissioning
• Musculoskeletal disorders
• National Health Service
• Service redesign

Acknowledgements

I wish to acknowledge the help of the MSk Core Strategy Group in preparing this paper and for permission to use audit data: Rochelle Bloch, Justine Currie, Stephanie Griffiths, Kate Laverty, Robert McLaren, and Neha Unadkat.

Declaration of interests

Funding none.

Ethical approval not required.

I.B. is a clinical advisor to NHS Ealing CCG and the Arthritis and Musculoskeletal Alliance. He is also a musculoskeletal physician with Ealing Hospital NHS Trust Community Musculoskeletal Service.

Note on references

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