Category: Scheme best illustrating Clinician/Manager Partnership
Name: Michele McCreadie
Job Title: Director of Operation and Clinical Quality
Organisation: Chesterfield PCT
Email: michele.mccreadie@chesterfieldpct.nhs.uk
Telephone: 01246 514303
Key team: Dominic Gage - Physiotherapist, Stave Finney - Podiatrist, Dr Mike Dornan – GP, Lesley Carmen - Commissioning Manager
Title: Right time, right place - managing demand for orthopaedic services
Need for Change:
- 20% increase in GP referrals to Orthopaedic consultants at Chesterfield Royal Hospital in 2002/03. Creating problems for patients and pressure on outpatient and inpatient waiting times.
- Intended achievements:
- Sustainable reduction of inappropriate referrals to Chesterfield Royal Hospital’s orthopaedic service
- Patient - timely access to the most appropriate part of the orthopaedic care pathway and more choice in options available
- Sustained self management programme
- Staff - role development and enhancement for physiotherapists and Podiatrists
- PCT / Trust - Achievement of waiting times. Cost avoidance of purchasing additional outpatients and operations from elsewhere
- How did we do it?
- Health Community agreement between managers and clinicians to Algorithms describing care pathway for common orthopaedic conditions
- Implementation of the Merle D’Aubigne hip and knee scoring system by GPs
- Implementation of a multi disciplinary clinical triage process for GP referrals requiring potential orthopaedic management
- Development of alternative services including assessment by extended scope practitioner physiotherapist, treatment by a podiatrist or physiotherapist services, direct referral to neuro-surgical consultants.
- The triage team includes an extended scope practitioner physiotherapist, podiatrist and GP, with referrals co-ordinated by the PCT commissioning team.
- Physiotherapists at Walton Hospital supported the education of GPs regarding the new pathway and the delivery of the new services
Impact:
- Within 6 months of implementing the service there has been the following results:
- 21% sustained reduction in request to orthopaedic consultants.
- Enhanced roles and new ways of working for physiotherapy staff.
- Reluctance of GPs to use hip and knee referral tool – Education and training provided by ‘champion’ GPs and supported by the PEC Chair
- Concerns from orthopaedic consultants and GPs regarding risk management – comprehensive risk management review system and evaluation process in place
- Lack of capacity in podiatry services and the creation of a podiatry waiting list – investment into additional podiatry space and staff.
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- Unexpected benefits:
- Enhanced career opportunities for physiotherapy staff
- Improved joint working between managers and clinicians within the PCT and the Royal hospital
- Improved podiatry services and facilities
- Improved multidisciplinary working between GPs and physiotherapists to the benefit of patients
- Two other areas in Trent are interested in our approach we have shared our ideas with them.
- Algorithms have been provided for Sheffield orthopaedic services and they are looking to adopt Chesterfield model.
