Reducing spend and increasing efficiency in MSK services
The journey –
This programme aimed to improve quality, reduce spend and increase efficiency inmusculoskeletal (MSK) services in East Sussex. Data on efficiency and spend in MSK services were presented to 70 participants at an event called Shaping the Future, where a number of key issues and possible solutions were identified. These included high rates of fractures and falls admissions, high rates of arthroscopy and of elective admissions, fragmented MSK services and variation in referral rates.
The programme has since focussed on pursuing solutions to these issues, including peer-review by GPs of referrals, agreeing surgical policies for arthroscopy and eight further orthopaedic procedures and introducing physiotherapy triage as an alternative to orthopaedic referral. In order to achieve change in systems and results, it has been necessary to influence culture and behaviour and seek consensus across a number of systems. Alongside this, an integrated MSK service has been procured in Hastings and Rother and commissioning of a similar service is being considered for the remainder of East Sussex in conjunction with other local commissioners.
Savings achieved in arthroscopy totalled £1.8million in 2010/11 and a further £600K in 2011/12 Interim outcomes for physiotherapy triage are encouraging, and there is increased interest in MSK from a primary care perspective. A service specification and business case has been agreed for a Falls and Fracture Liaison service for East Sussex and work is underway to implement Shared Decision Making – critical to ensuring that patients are fully aware and have the option to participate in decisions about their care, particularly where more than one treatment option may be available.
|In-patient X||Out-patient X||Community based X|
|Mental health||Chronic illness X||Cross-systems X|
|Staying healthy||Maternity and newborn||Children and young people||Acute care|
|Planned care X||Mental health||Long-term conditions X||End of life|
Information, tools and techniques used
The programme has used a range of national and regional best practice tweaked for local use. For example, the Framework for Musculoskeletal Services, National Institute of Clinical Excellence, surgical policies from other PCT areas, data from the NHS Atlas of Variation and the South East Public Health observatory.
The programme covers East Sussex, including East Sussex Downs and Weald and Hastings and Rother PCTs; in the process of becoming three CCGs in Hastings and Rother; Eastbourne, Hailsham and Seaford; High Weald Lewes and Havens. Partners involved in the work include East Susses Healthcare Trust, The Horder Centre (a private orthopaedic service), Brighton and Sussex University Hospitals and a range of independent physiotherapy, MSK and orthopaedic outpatient services.
The programme started in 2010 and is still ongoing.
Contact details and further information
Fiona Streeter, Service Development Team Leader, East Sussex: firstname.lastname@example.org