ICATS Strong NHS support WHY? High referral rates, long waiting times, low conversion to surgery Whole system approach Typically MSK Multidisciplinary team Triage – skills matching
ICATS Paper triage, then refer to either Physio Back programme Pain clinic Spinal surgeons (Back to GP) Virtual spinal clinic
ICATS Improves patient experience eg access Control ‘up front’ Reduces referral rate to secondary care Reduces initial costs BUT Sufficient depth of skills & expertise? Truly integrated? Medical ‘buy-in’ 15-20% re-referral rate after initial referral? Old services & models still exist
13 “We introduce the new by allowing the old to continue … … therefore the new only add cost.” Professor Paul Corrigan, Kings Fund. Reduce secondary care referrals
Service Redesign 1Clinically led; appropriate clinical model 2Follow & control whole patient's journey or care p athway 3Involve all stakeholders 4Effective multidisciplinary team 5Focus on patient experience and optimising care outcomes
Costs Less consultant time Low f-up : new ratio Low DNA rates Few secondary care referrals Pregabalin?
Spinal Surgical Referrals? 10% referred (10%) 65% had procedure (20%) 42% of those referred had surgery (10%)
First Hospital OP Attendances n
All Secondary Care Pain Management Deprivation adjusted SAR
First Spinal Hospital OP Costs £
‘If clinicians are not part of the solution, they are part of the problem’ Clinical engagement GPs, specialists and other clinical staff must be engaged in managing budgets and with service redesign to bring outcomes, experience and cost together.