6 November 2003 Multiprofessional Working – a new orthopaedic model Dr Sarah Schofield Southampton Health Economy

6 November 2003 Dr Sarah Schofield GP PCG Chairman Sabbatical at Southampton University Hospitals Trust (SUHT) Chairman, Whole Systems Orthopaedic Board Assistant Medical Director, SUHT Assistant Medical Director, ETVS PCT

6 November 2003 Today Background What has been achieved Successes and Challenges How Where to from here

6 November 2003 Orthopaedics August 2000 Waiting times targets CHI Serious clinical incident Low morale Complaints Lack of confidence in the service

6 November 2003 Patient pathway Workshop Patient pathway Prevention Outpatients Inpatients Discharge processes Community care

6 November 2003 Orthopaedic Outpatients August referrals per month 400 appointments available 40% conversion rate 18 month wait for appointments Reducing targets for waiting times (NHS Plan) Complaints and dissatisfaction

6 November 2003 Solutions Traditional solution Clerical/clinical validation Multiprofessional Triage Scheme

6 November 2003 Multiprofessional Triage Pilot started January 2001 Romsey Hospital Lower limb team Second team started summer 2001

6 November 2003 Multiprofessional Triage Team of professionals working together 30 minute appointments Patients see one professional with input from others when necessary Not treatment service but fast track into other services 6 weeks waiting times

6 November 2003 Governance and Education Monthly sessions in acute trust Competency framework Appraisal and review Training together MSc Patient feedback

6 November 2003 Triage Teams Lower Limb Physios GPwSI Podiatrist 3 Teams Radiographer Upper Limb Physios GPwSI OT 2 Teams Backs Physios GPwSI Podiatrist Nurse 2 teams

6 November 2003 Structure 3,000 patients 2002/03 Central management 3 lower limb teams 2 upper limb teams 2 back teams 52% patients referred back to GP 20% patients referred onto outpatients

6 November 2003 Ripple Effects Community services Informed patients Conversion rate Pressure on inpatient lists and targets Training of junior grades and students Workforce issues

6 November 2003 Successes Access – time & geography Expertise Long appointments Access to other services Patient satisfaction Education – patients, Teams, GPs Cost Waiting times targets

6 November 2003 Challenges Staff contracts Working across boundaries Evolution Suspicion Workforce Estates Rollout

6 November 2003 How? 4 individuals Legwork Networking Recognition that people are much more inclined to support what they help create, and resist what is forced upon them Win-win Computer modelling

6 November 2003 How? Flexible approach Pilot Education a priority Champions – management and clinicians, primary and secondary care Understanding of whole pathway Link to Whole Systems

6 November 2003 Future Part of whole systems plan Referral broker Managed Care MSc Other specialties

6 November 2003 Summary New service which was set up to provide care in the right place at the right time with the right professionals, with the patient rather than the system at its centre