MSK Services MSK JOURNEY

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1 MSK Services MSK JOURNEY

2 White Paper Good Leadership Is About Looking Across Boundaries, Not Standing Behind Walls and Defending Professional Self Interest. MSK Services Framework Called for Shared Care and a Patient Centred Approach.

3 Turkey s Voting for Christmas MSK Services Podiatry Physio Out Patients MSK Services OT Out Patients In Patients Orthopaedics Orthotics Services Therapy Admin Long Term Conditions Neuro Out Patients & In Patient unit Amputee OT & PT Stroke SLT In Patients & Out Patients & Public Health Children's Services Including CDC N&D Acute & Planned Care All In Patient Care, General Surgery, Medicine, Critical Care, Elderly Medicine, In Patient Cardiac & Pulmonary Care Women's & Men's Health Falls

4 OMG or Changing Cycles Disruption & Loss Disorder Chaos & Fear Emerging Order New Relationships & Acceptance Other cycles going on at the same time

5 My Challenges Must start thinking differently Not to entrench in my service Look across all professions Seeing opportunities & be proactive Had to prove my worth Be determined Exhibit leadership behaviour Manage the transition

6 My Way Ask questions & listen Give thanks & praise Get out there Display enthusiastic Find out what pushes buttons TNTS Find win win proposals Encourage creativity New approaches Cultivate trust and respect Willing to share risks Remove boundaries & barriers Test bed for inter professional practice Exist harmoniously Use skills within the teams & staff Allow staff to thrive Cultivate mutual trust and respect Banish assumptions & misconceptions Know their local problems/issues Look on the bright side Be altruistic Be consistent Be dependable Have high ethical standards Demonstrate personal commitment Use Demming principles Identify champions Strengthen clinical leadership Give more freedom Loyal & trustworthy

7 Wow All That Budget Maximise resources to deliver best services Via funding Opportunity to increase productivity Opportunity to support early and upstream intervention and reablement Reduce variations and more standardisation of pathways AHP Brand - commission pathways

8 Advantages of MDT Working Raised awareness of the Podiatry Profession Joint Assessment and treatment Working in close proximity and shared working environments Learning from colleagues Learning the scope of practice Shared information, agreed pathways

9 Examples Expertise in less familiar areas can enhance efficiency. Pod to Physio. Many Pods will struggle to differentiate between peripheral nerve compression problems and neurodynamic problems. Screening tests to decide their future direction can be very quickly and easily undertaken avoiding placing a patient on a waiting list. Physio to Pod. Management of trochenteric bursitis, evaluation of malaignment. Fast screening can profoundly enhance patient management.

10 Examples - Cont Learning from colleagues. Physio to Pod - Greater emphasis and depth of patient history taking, better understanding of the mechanisms of pain and the subsequent categories for which they exist within, Podiatry within Biomechanics is generally focussed on mechanics which may cause pain ( i.e. the mechanical nociepters) and may be slow to take into account other factors such as neural or psycho-social issues. Pods have benefited from the systematic approach to MSK examination by adopting techniques commonly used in Orthopaedic medicine though not ususally taught at undergraduate level to Pods, staff have greatly increased their diagnostic skills. A great deal of physio assessment often takes place with the patients lying down on a couch. Pods tend to assess in weight bearing and more readily use gait which can be an advantageous approach to some MSK problems that arise in Physio clinics.

11 Examples - Cont Learning from colleagues. Pods & Physios have benefited from input and feedback from the consultant Rheumatologists in recognising rheumatological presentations and making appropriate referrals early referrals, saving patients time and suffering as well as AHP time on treatments that are likely to fail. Consultant radiologists and Orthopaedic surgeons can often enlighten with ideas in difficult cases, again this enhances the experience of the AHP clinician increasing their level of expertise.

12 Examples - Cont Learning the scope of practice of other professions and when intervention and inter-referral is appropriate (Mentioned in 10 key roles DOH 2000) Would many Pods know when neuro-surgery is likely to be undertaken for pain/parathesia affecting the foot ( L5/S1 dermatome)? Patients can report pain in the foot that is referred from the low back without interdisciplinary help how would they cope? When would an orthopaedic surgeon consider operative intervention on a Morton's neuroma or a hammer toe? Again there are time and money savings that can often be made by an early appropriate referral.

13 Examples - Cont Shared working environment. Advantages for Pods, Physio clinics are larger and allows assessment of patients walking, standing, stretching etc, especially Physio gym which has steps, raised platforms for static examination of the weight bearing foot as well as wall bars used to demonstrating exercises. Equipment often used in Podiatry such as Doppler, thermometers, neurothesiometers, can be very useful to Physios in differentiating between vascular origins, inflammation, stress fractures etc. Physio have access to Physio tools which Pod do not often have.

14 Examples - Cont Shared information, agreed pathways ( mentioned in 10 key roles). If a new research paper suggesting an enhanced technique or proving new evidence arises it can be shared for best practice e.g. recent change to enhanced exercise programme for insertional Achilles tendinosis. Pathways can be agreed incorporating evidence based practice across disciplines that can at the least provide a minimum expected standard for the treatment of common conditions.

15 Work in Progress Podiatry Direct E Consultation OH MSK Team A&E MSK Team One point of entry for MSK conditions Diagnostic ESP s working alongside Orthopods AHP s in # clinic ESP s direct listing patients for surgery Exercise Therapists/assistants to deliver rehab classes

16 So Last Year Dahling TCS Integration Restructuring AQP

17 My Message If you do the same as always you will always get the same, the best way to predict the future is to create it. In these times of change we must be on the pitch not in the commentary box.

18 Thank You Lynda Parkinson Head of MSK Services Harrogate & District NHS FT