Item 12.2.1 Report Number dchp 29/2014 Dundee CHP Committee 19 June 2014 MUSCULOSKELETAL ADVICE AND TRIAGE SERVICE (MATS) 1. SITUATION AND BACKGROUND NHS Tayside implemented MATS on 11 November 2013, with Salus as the provider. Previous boards have used NHS24 as the service provider. Prior to implementation of MATS NHS Tayside had already completed the redesign of the MSK pathway, including the following elements being fully embedded: GP referral guidance tool All Band 7 and upwards MSK physio staff trained and able to order x-ray, MRI and Ultrasound scans. Escalation pathway for all MSK physio staff Referral Management System (RMS) for GP to Physiotherapy electronic referrals via Sci-gateway All Physiotherapy MSK services using TOPAS the computerised appointment system in NHS Tayside. Work shadowing for Band 7 and above MSK physio staff with Orthopaedic consultants, GP with special interest and Physiotherapy Advanced Practitioners. In the few weeks prior to the implementation date of 11 November, all GP surgeries across Tayside were visited and blue business cards, posters and information sheets were delivered. Press releases in the local papers and radio station advised the general public of the change in referral process. It is worth noting that NHS Tayside Physiotherapy services have had Direct Access to Physiotherapy (Self-referral) for a number of years and a decision was made that the implementation of MATS would in fact replace the previous self-referral mechanism e.g. instead of patients being given or collecting a self-referral form at their GP surgery they would be given or pick up one of the MATS business cards which directs them to phone the MATS phone number for advice and/or referral into MSK services. The aim of this service is to provide access to a call centre facility for the population of Tayside whereby they can access advice and support on the management of a Musculo-skeletal issue or condition. The call centre acts as a first port of call and a standardised approach is followed to elicit information on demographics and the presenting condition/situation. This information is then triaged resulting in one of the following 5 outcomes or referral for the caller: 1
1. Clinical Supervision 2. Back Scoring 4 or more on the STaRT Tool. 3. MSK Service referral 4. Working Health Services Scotland referral (WHSS) 5. Self-Management For 1 and 2 the patients will receive a telephone consultation from a senior physiotherapist in NHS Tayside. This is to ensure that serious pathology is excluded and to support more appropriate pathway for patients. Outcomes may include: self management, physiotherapy referral, refer to GP, discharged with advice, onward to referral to more appropriate profession (biomechanics, occupational therapy, orthotics etc) For 3 patients are referred directly into the mainstream physiotherapy service. For 4 patients are referred directly into the WHSS service. For 5 patients are provided with self management advice. If the self management advice does not alleviate the problem, patients call back to the MATS number and will be referred for physiotherapy. 2. ASSESSMENT Table 1 Table 1 below shows the total number of calls received per week for the first 16 weeks of the project. There has been a significant increase in the total number of calls received from week 9 onwards. Salus have increased their resource to be able to meet this increase in demand. 2
Table 2 Table 2 shows average time to answer the call to the MATS service. Table 3 Salus have worked hard to ensure the answer time has improved and 80% of calls were answered within one minute during weeks 15 and 16. Table 3 shows the outcomes of the triaged calls on a weekly basis. 3
Table 4 Table 4 shows the figures for the outcomes form NHS Tayside physiotherapy telephone consultations. Overall Calls 300 Number of patients 250 200 150 100 50 0 LBP C.S LBP C.S LBP C.S LBP C.S LBP C.S LBP C.S November December January February March April Month Ortho Biomechanics Womens Health Audiology CRT Cancelled Wrong Number No attachment No Reply GP Discharge Self Management Physio Nov Dec Jan Feb Mar No. referred for physiotherapy telephone consultation 184 297 433 401 382 % referred for physio 73 73 75 76 75 % referred for physio who received telephone consultation 82 84 84 85 83 This highlights that a significant number of patients 24-27% monthly did not require to receive a face to face appointment with a physiotherapist. This figure includes those patients who the physiotherapy service were unable to speak to, for a variety of reasons (failed to answer phone, incorrect details supplied by Salus) so the percentage of patients not requiring a physio appointment reduced to 15-18%. 4
3. SUMMARY The service has been in operation since 11 November 2013. The number of calls to Salus have been higher than anticipated and have increased markedly as the service became embedded Salus have managed their resource locally to improve service delivery. Some errors have been made (incorrect patient data, referrals not being sent to NHS Tayside) and these have been investigated with control measures put in place. Formal data locally from NHS Tayside measuring the impact is not yet available. The TOPAS team are aware of the requirement and are working on producing this. The triaging of patient by Salus is removing approximately 6% of total referrals to Tayside by providing self management to these patients. Salus have been asked to collect and share data on how many of these patients call back into the service and receive physiotherapy referral. NHS Tayside physiotherapists providing the telephone consultation service are able to direct 15-18% of patients to self management thereby reducing the demand on NHS Tayside services. Formal verified data is not yet available form the TOPAS team to fully evaluate this service, however, each CHP is reporting a reduction in the total number of patients currently on waiting lists with average waiting times reducing. Although there have been fairly significant issues setting this service up with negative comments from some GP s and patients the service has worked hard to address all issues/concerns raised. A large number of patients have praised the service (in particular the physiotherapy telephone consultation aspect) which provide patients with far faster and easier access to highly specialist professional advice often on the same day that the patient visited their GP or made the call to MATS previously this would have taken several days at best, often several weeks. Karen Anderson Head of Allied Health Professions Dundee CHP Bill Nicoll Director of Community Services NHS Tayside Matthew Kendall Head of Physiotherapy & Community Therapy Services Dundee CHP 9 June 2014 5