I'm Dr Stephen Fawcett, I'm a GP in Stoke-on-Trent.
I'm also the medical director for the local CCGs, which I've done for a few years now.
I've been a GP in the city for 25 years plus.
And what I really wanted to talk to you about was how we've tried to help elective referral
pathways to try and make them better for the patients, but actually make them better for
the GPs as well.
So we really introduced the integrated MSK Triage pathways because of increasing delays
within the system, because a lot of the activity was taking place in the wrong place, so it
wasn't the right patient at the right time, if you like.
Services were becoming increasingly complicated for patients to navigate; for the GPs to navigate,
and rolling it into an integrated single solution meant that a lot of that uncertainty was taken
away.
And also because colleagues were asking for some simplification of how the systems would
work and how they'd get the best out of those services.
So an integrated MSK service seemed the right way to go.
Using an integrated MSK service for practices has a number of benefits.
Probably the most obvious one is taking some of the administrative burden off practices,
because when a patient comes in with a musculoskeletal problem that needs input from outside the
practice, we currently have to go delving into Choose and Book, or e-referrals as it
is now, and then we have to start managing choice for the patients.
Now that might be the clinician or one of your administrative team, but nevertheless
that is a burden that you could do without.
Having the integrated service means that we can refer into an MSK pathway and if they
need any particular intervention, for example an operation or some other intervention, the
service will manage that themselves.
So they refer outward, back to our Choice and Referral Centre, who manage that all for
them.
So for the patient it seems seamless, for the GPs it's a bit fire and forget -- you've
done your piece of work, you've got the patient on to the right pathway, you don't need to
fret about it any more.
In terms of quality and in terms of clinical sovereignty, if you like, all the referrals
are triaged and then there's an assessment where they go.
Where there sometimes isn't enough information the triage service could potentially contact
the GP but in my experience that happens incredibly rarely.
And patients find it much easier and they're not ringing the practice back asking for updates
or "where am I in the system?"
The MSK service manages that for them.
And generally it also gives them a degree of open access when they're actually in the
pathway, which means that when you're on a Monday morning triage surgery you're not getting
calls from patients saying "when's my appointment for my shoulder procedure?"
The service manages that for them.
The advantages for patients are that they get rapid assessment by an appropriate clinician,
and that can't be understated because if you refer to orthopaedics generally you'll be
waiting, you know, 16 to 18 weeks and then you'll have the assessment and so forth; certainly
locally.
Whereas within the MSK Triage type service you will generally see a consultant physio
within about a week to 10 days, and then will get put through to the other parts of the
pathway that you need.
So for somebody, for example, we had a patient who was a bricklayer the other day who's got
shoulder problems -- and shoulder problems can sometimes be quite complex.
When we refer into the MSK service, they will get an assessment by a consultant physio or
some other appropriate physician, and then they get the diagnostics really quickly.
So generally speaking they'll have an ultrasound and a plain film on their shoulder usually
within a few days; sometimes on the spot.
Now compare that to the pathways the GPs have.
If I start the investigations at the practice what will happen is that I'll send off an
ultrasound, which may take four weeks to happen, and the X-ray will be fairly quick.
Then we say, oh look, they've got bursitis, they need something doing to them.
Actually we then have to arrange that -- now I could possibly inject it in practice but
it's quicker to go through the MSK so it runs really quickly.
The other bit is that they're getting an expert opinion and they've got consultants embedded
within the service so if they need, you know, somebody more expert and somebody more specialised,
that's available to them.
But the beauty is for the consultants they're just seeing the patients they need to see,
not everybody, so the ones who really need it get access to the expertise, and the ones
who can be dealt with in different ways are dealt with differently.
And because it's a single point of contact for them, there's much less hassle in terms
of, you know, arranging follow-up or understanding where their appointments are.
They don't have to ring lots of different services -- there's a single number they ring
and that's it.