This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

Commissioning

BRITISH SOCIETY FOR RHEUMATOLOGY AND ROYAL COLLEGE OF GENERAL PRACTITIONERS LAUNCH INITIATIVE TO IMPROVE CARE PATHWAYS FOR PEOPLE WITH INFLAMMATORY ARTHRITIS

In May 2017, BSR and the RCGP have launched a joint Quality Improvement project to improve care for people living with inflammatory arthritis. The joint project will deliver a suite of online resources to help improve pathways between primary and secondary care, with a focus on reducing delays to diagnosis and creating standardised, shared care agreements. The recent National Clinical Audit for rheumatoid and early inflammatory arthritis revealed delays in referral from primary care to specialist treatment for people with suspected inflammatory arthritis, with only 17% of cases being referred within the three days recommended by NICE. Early diagnosis and treatment is crucial to prevent joint and organ damage and reduce potential disability.

Furthermore, once people are established on a treatment plan, their care is shared between primary and specialist care through joint agreements on prescribing and monitoring of high-risk drugs such as Methotrexate.  These shared care agreements are numerous and vary from locality to locality; there is therefore an opportunity to reduce risk by standardising and streamlining these agreements.

This one-year initiative will be led by the newly appointed RCGP Clinical Champion for Inflammatory Arthritis, Dr Danny Murphy, a GP principal in Devon with a special interest in rheumatology, who also works as a part-time staff-grade rheumatologist at the Royal Devon and Exeter Hospital. In addition to various research projects in rheumatology, Danny has also advised on the development of the recent BSR guideline on Biologics for the Treatment of Axial Spondyloarthritis.

Inflammatory arthritis affects close to a million people in the UK and includes conditions such as Rheumatoid Arthritis, Axial Spondyloarthritis and Psoriatic Arthritis. This project, in conjunction with the ongoing work through the national audit, will make a significant impact on care for people living with these conditions.

 

Commenting on the collaboration, BSR President, Dr Peter Lanyon, said:

“This new collaboration between BSR and the RCGP is a really important strategic initiative, aiming to improve the care pathways for people who live with inflammatory arthritis. We greatly welcome the appointment of Dr Murphy as the first ever RCGP Clinical Champion for Inflammatory Arthritis. This will undoubtedly raise awareness of these conditions across the RCGP membership and beyond. It’s a great opportunity for clinicians in primary and secondary care to work more closely together to develop national solutions to help reduce delays to diagnosis and deliver better co-ordinated care.

This is a view echoed by Professor Helen Stokes-Lampard, Chair of the RCGP, who stated:

“We’re delighted that the College is partnering with the BSR to raise awareness of this important clinical area in general practice. This collaborative project aims to support our members and their practice teams in the identification and appropriate management for patients living with Inflammatory Arthritis throughout the UK. I look forward to being involved in this project, and following its progress and the impact it has on GPs, our teams and our patients.”

Expressing his honour at being appointed, Dr Danny Murphy, the new Clinical Champion remarked, “I am very proud to be the RCGP’s first Clinical Champion for Inflammatory Arthritis, and am looking forward to working closely with the RCGP and BSR over the next year. Our aim for this project is to empower primary care practitioners to deliver the best possible care to patients with Inflammatory Arthritis, by focusing on eLearning, curriculum updates and engagement with commissioners.”

Putting forward models of care and examples of practice for the NHS is a large part of how Sport and Exercise Medicine (SEM) is influencing the MSK landscape. The Faculty of Sport and Exercise Medicine’s Fresh Approach in Practice NHS information document remains useful and relevant when communicating what works and how SEM can improve outcomes and make real cost savings in MSK care.

Members and Fellows of the FSEM are now putting forward their evidence for SEM-led MSK services to help provide much needed examples. Recently featured in the FSEM’s response to the Scottish Preventative Agenda Inquiry was NHS Tayside MSK Clinic, put forward by Sport and Exercise Medicine Consultant Dr Niall Elliot, which over a 10 year period, seeing approximately 800 patients per year in one session per week, has created a £500k – £650k saving for the NHS.

 

Shared decision making pilot

Arthritis Care has expanded our unique service into South Tees. The local CCG has commissioned a pilot, recently launched, which uses a shared decision making tool to help people with arthritis considering knee and hip replacements to explore their options and learn about self-management techniques.
 
Green paper response

In our response to the Work, Health and Disability Green Paper, Arthritis Care welcomed the focus on musculoskeletal conditions but urged the government not to force people to engage with employment support if they are not well enough.

Our response is available here.
 
You & Yours

Arthritis Care has recently contributed to BBC Radio 4’s You & Yours programme, along with a number of other arthritis charities, for their three day mini-series on arthritis.

The series aired between 22-24 February 2017 and focused on work and arthritis, young people and arthritis, and treating arthritis. You can listen to the first part here.

 

New report ‘providing physical activity for people with musculoskeletal conditions’

Arthritis Research UK are pleased to be launching our new report ‘providing physical activity for people with musculoskeletal conditions’ at the Local Government Association/Associated Directors of Public Health conference on the 9th of March at the Victoria Park Plaza hotel in London.

The report has been produced in partnership with the Department of Health, Public Health England and NHS England and is intended for organisations responsible for commissioning and providing local services, as well as musculoskeletal and physical activity organisations who may find it of interest. It summarises the evidence of the benefits of physical activity for people living with musculoskeletal conditions and presents a framework for local physical activity provision to meet the needs of people with musculoskeletal conditions

We have secured a speaking session at the conference to talk about the work detailed in the report from 12.25 to 11.15 pm. This will be chaired by Dr Benjamin Ellis, Senior Clinical Policy Advisor at Arthritis Research UK and we encourage anyone attending the conference to join our session.

nv-mccracken_250What is a good outcome?

We’re two years into delivery of the Five Year Forward View, the document heralded as a blueprint for bridging the gaps in finance, quality and prevention. Chapter Two of that seminal document sets out a vision for a ‘new relationship with people and communities’…

But what does that actually mean?

The Realising the Value programme has spent 18 months seeking to turn those words into a more deliverable reality. It is an important body of work delivered by Nesta, the Health Foundation, National Voices, Regional Voices, NAVCA, Volunteering Matters and others.

The team behind the programme have examined the evidence for person- and community-centred approaches such as peer support and education for self-management. They have developed the approaches with sites across the country, and recently published an array of tools, guides and recommendations. It’s good stuff and there is pretty much something for everyone: from system level recommendations, to an economic modelling tool for commissioners and practical guides for service providers.

Together, all of these materials paint a very different picture of what ‘good’ looks like in health and care.

Currently we measure clinical outcomes, systems outcomes, and the immediate outcomes of a single service or treatment. If we are to re-focus services on the needs of people and communities, we need to also be looking at the outcomes of all of the services that support a person and measuring wider health and wellbeing impacts, such as quality of life, and people feeling in control and independent.

To put that into real-speak; if a person who has had what the NHS would consider a clinically successful knee operation discovered that they’re left unable to continue their favourite hobby of gardening (thus facing the prospect of also losing one of their few social connections through their gardening club), is that actually a good outcome for that person?

As health and care services develop new models of care, adopt place-based approaches, and work in new ways with new partners, they will need new outcomes by which to set their goals and measure their success. Because the aim is to integrate systems and services in a ‘place’, we need common and consensual outcomes that can be used by the health, social care, public health and voluntary and community sectors equally. Integration requires a shared vision and shared values and outcomes.

It is for this reason that one of the most important recommendations from the Realising the Value programme is the need for a new, shared and simplified outcomes framework focused on what matters to people.

At the Manchester launch event for Realising the Value, one anecdote summed up how far we have to go in recalibrating our concept of ‘value’ and what ‘good’ looks like in health and care. A presenter from Being Well Salford described how a charity health coach was the first person to ever ask him what he wanted, “The rest told me what they offered, mostly just meds.”

The new relationship with people and communities means refocusing health and care services to deliver what people actually want and need.

Andrew McCracken is Head of Communications at National Voices, the coalition of health and care charities.
@hellomccracken

Jill_Firth-pennine-mskby Dr Jill Firth, BHPR President, Consultant Nurse in Rheumatology and Director for Service Improvement at the Pennine Musculoskeletal Partnership Ltd in Oldham.

Over the past 20 years of working as a special  ist nurse, I have witnessed first-hand the changing face of care for people with Musculoskeletal conditions (MSK) – particularly Rheumatoid Arthritis – leading to better outcomes for patients.

This can, in part, be attributed to advances in treatment strategies, including biologic therapies, but is also a consequence of better access to care provided by a multi-disciplinary team (MDT) comprising consultant rheumatologists, specialist nurses, physiotherapists, occupational therapists and podiatrists as a core nucleus.

Data emerging from the second year of the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis provides further evidence of the importance of this team approach in achieving NICE Quality Standards for the management of RA and other MSK conditions.

pennine-msk-quoteIn year one of the audit we found that higher numbers of consultants were associated with shorter waiting times to first appointment, facilitating early diagnosis and rapid access to care. Only 37% of patients were seen within three weeks of referral (NICE Quality Standard 2) and 25% of patients waited seven weeks or more for a specialist assessment.

The Royal College of Physicians recommend that one rheumatology consultant for every 86,000 people is needed to provide an adequate service, but this year’s audit found only one rheumatologist for every 116,000. Less is known about recommended workforce models for other members of the multi-disciplinary team.

This year we have undertaken additional analyses which demonstrate that higher numbers of specialist nurses are significantly associated with patients starting combination disease modifying drugs within six weeks (NICE Quality standard 3). Early access to combination treatment is crucial to improve pain, maintain function, aid work retention, and protect joints from irreversible damage in early disease.

Higher specialist nursing numbers are also associated with the prescription of short-term glucocorticoids which are used to bridge the gap whilst slow acting disease modifying drugs have chance to work, helping to control inflammation in the joints in the interim. Nurse led clinics facilitate treating to target and this data builds on existing evidence from RCTs demonstrating that specialist nurses provide high quality, cost-effective care for patients with inflammpennine-mskatory arthritis.

It is encouraging that we are starting to see successful business cases for additional consultant and specialist nurse staffing as a result of the year one audit findings.

Investment in additional specialist staff delivers improved outcomes for patients and has the potential to reduce the long term costs to the NHS and wider health economy. The reconfiguration of existing referral pathways, services and staffing through changes in referral pathways and organisational structure, such as the provision of early arthritis clinics, can also make improvements at no-cost.

Overall though, as in year one, there were many gaps in in access to the MDT: 72% of providers reported that their patients have access to specialist physiotherapy; 76% to specialist occupational therapy and 51% to specialist podiatry with marked regional variation. Despite the fact that 90% of people with RA experience foot problems, the provision of specialist podiatry remains markedly low indicating room for improvement.

Timely access to the specialist MDT is crucial not only in early RA but to support people living with a long term condition that is characterized by a fluctuating course. The added value of specialist nurses and allied health professionals working in rheumatology has long been recognised by our medical colleagues, primary care teams, patients and carers but we need to ensure that service managers and commissioners fully appreciate our worth to drive improvements in care. Only then can we work together to configure services that meet the needs of our patients with clear pathways and high quality cost effective care provided by appropriately trained and skilled workforce.

British Society Rheumatology is promoting a webinar, as part of the MSK Network Series of webinars, on 30 September 2016, 12.00-13.00: “Coordinating a person-centred pathway to high quality care for people with rare autoimmune disorders”.

The webinar is presented by Ben Fisher from the University Hospitals Birmingham NHS Foundation Trust, who was British Society Rheumatology Best Practice Awards 2016 awards winner in the Outstanding Best Practice category.

In this webinar we describe how we have set up a multidisciplinary clinic run by rheumatologists and attended by oral medicine and ophthalmology to streamline the diagnostic pathway and reduce frequency of visits. Key components are access to a slit lamp for eye examination, provision of a lip biopsy clinic, and standardised histopathological reporting following guidelines we have developed.

  • The webinar is aimed at commissioners, clinicians and providers.
    Once you have registered you will be sent a calendar invite containing details on how to join.

Arthritis Care’s innovative commissioned service with West Berkshire Commissioning Support Unit (CSU), covering four Clinical Commissioning Groups, has moved from a two-year pilot to a contracted service. The service enables individuals to make better informed decisions around if and when to undergo knee or hip replacement surgery.

Joe Smart, Transformation Lead from the CSU confirmed “a new contract has been agreed with Arthritis Care which offers excellent value for money and enables the charity to bring in additional resources to provide the service on a larger scale”.

The NHS has confirmed that the service saw 642 patients over two years, of which only 98 have gone on to have a surgical intervention within 24 months of receiving our service. The resulting 544 fewer surgical interventions over a two year period was credited with generating savings to the NHS of £2.6 million.

ACare-895000

NV-Six-principles-diagramThe People and Communities Board, one of the Five Year Forward View programme boards, has published Six principles for engaging people and communities: putting them into practice.

The principles offer a practical steer on developing the ‘new relationship with people and communities’ set out in the Five Year Forward View. The six principles aim to help build knowledge, confidence and motivation to develop person centred, community-focussed approaches to health and care.

The principles will be useful for anyone engaged in transforming health and care – including Sustainability and Transformation Plan leads, local authorities, CCGs, NHS Trusts, GP surgeries, frontline staff, and the voluntary and community sector. www.bit.ly/thesixprinciples