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Changes to musculoskeletal services in Oxfordshire

10/10/2017

Oxfordshire Clinical Commissioning Group went out to tender for a musculoskeletal (msk) assessment treatment and triage service (MATT) in July 2016. This covers areas such as physiotherapy and orthotics.

At the time musculoskeletal services were provided under different contracts with various providers (Oxford University Hospitals NHS Foundation Trust and Oxford Health NHS Foundation Trust).

These contracts were commissioned at different times and were not designed to work together. Feedback from patients and GPs was that the waiting times for some patients were too long and the clinical commissioning group needed to find a new way of providing options for swift advice and earlier treatment. Several attempts had been made over previous years to improve provision of these services; but the focus of review and change had tended to be on individual areas of service rather than the whole system.

The CCG’s aim was to commission a service where people with musculoskeletal conditions could access high quality, effective and timely advice, assessment, diagnosis, triage and treatment at the right place first time.

It developed a commissioning strategy for a service which was efficient and provided a quality service across Oxfordshire. It needed input and engagement from patients, the public and clinicians to develop this new service.

Before putting the service out to tender, the CCG carried out a widespread consultation and engagement process, details of which can be found at https://consult.oxfordshireccg.nhs.uk/consult.ti/MSKsurvey/consultationHome

 New provider

Following the procurement process, which attracted bids from Oxford Health NHS Foundation Trust, Healthshare Ltd, Connect Physical Health, Central and North West London NHS Foundation Trust and Virgin Healthcare, the contract for muscoloskeletal services was awarded to Healthshare Ltd. Oxford University Hospitals NHS Foundation Trust did not bid to provide this service.

Patient representatives made up part of the evaluation panel to review the applications.

Healthshare Ltd works within the NHS and is solely funded through NHS contracts; it does not carry out any private physiotherapy work and its services are free to patients in the same way as other NHS services.

Most of the staff who have been providing the service Oxford Health and Oxford University Hospitals will continue to do so; they will transfer to be employed by Healthshare Ltd, so current patients will have continuity of care with familiar faces.

 Locations

Physiotherapy appointments will be provided at various locations across Oxfordshire. Many of these are the same as before, others will be in new locations. The locations include:

  • In Banbury, the service will be located on the Ramsey Treatment Centre on the Horton General Hospital site
  • In Bicester the service will be located at Bicester Community Hospital
  • In Oxford City the service will be located at East Oxford Health Centre
  • In West Oxfordshire the service will be located in the Deer Park area and at Chipping Norton Medical Centre
  • In South East Oxfordshire the service will be located in Townlands Hospital in Henley and at Wallingford Community Hospital
  • In South West Oxfordshire the service will be located at White Horse Medical Practice in Farringdon and Woodlands Practice in Didcot.

 In addition, Healthshare Ltd is negotiating with Oxford Health to use its Wantage Hospital facilities to offer services. Wantage Hospital previously hosted musculoskeletal services when they were provided by Oxford Health. The number of sites will be increased once the service is fully established.

 What will the new service deliver?

The MSK Assessment Triage and Treatment service (MATT) replaces the current system for delivering same-day diagnostics where possible, primary care physiotherapy and podiatry, orthopaedic medicine and medicines advice and management, but will be provided from locations evenly spread across the county to ensure care can be delivered closer to home.

This will include both conventional sites such as GP practices and leisure facility-based sites.

According to Oxfordshire Clinical Commissioning Group, “the new model of care promotes shared decision making and has a strong emphasis on self-management with patient facing tools to help with this. Patients will also experience shorter waits once the previous providers’ waiting lists have been cleared by Healthshare Ltd”.

The commissioned services will offer: signposting, advice, triage, referral, assessment, treatment and advice back to the referrer and community based musculoskeletal physiotherapy, musculoskeletal podiatry and pain management.

 The service aims to:

  • Provide care by appropriately qualified clinicians in the right place, first time.
  • Give patient choice on treatment options and location of treatment.
  • Improve the quality and cost-effectiveness of the service.
  • Ensure patients input to their treatment plan particularly where the problem is long term.
  • Provide services that have a strong emphasis on patient education and self-management, thereby promoting active, healthy lifestyles and reducing recurrence of injury or illness.
  • Provide feedback, advice and guidance via phone, email and face-to-face to patients and referring clinicians on how conditions can be managed within primary care where appropriate, or provide advice and guidance on requests to encourage and promote up-skilling in primary care.
  • Ensure patients are managed within a maximum waiting time of six weeks. Where clinically required to do so, the provider will promptly refer the patient to secondary care services to avoid unnecessary delays.

 Transfer of patients

The transfer of the service is being carried out to ensure as little disruption as possible to patients' appointments. However, because the transfer involves moving on to a new booking system, patients who already have an appointment for after September 15 have been sent a letter advising them that their appointment may be cancelled and that Healthshare will book a new appointment for them as quickly as possible.

Patients do not need to contact Healthshare Ltd themselves. There has been some public concern about these changes but Healthshare Ltd has tried to reassure patients whose appointments will change.

For more information relating to this briefing please contact OCCG at sarah.adair@oxfordshireccg.nhs.uk

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