Greenwich Council

Agenda item

Circle MSK Service – Update report

The Panel is asked to receive and consider the attached presentation from Circle MSK.

Minutes:

The Director of Integrated Care Operations from Circle MSK presented this item, supported by the General Manager, Long Term Conditions from Lewisham and Greenwich (L&G) NHS Trust and the Managing Director of GCCG.   The presentation covered the scope of the service, referral numbers and key performance indicators and the work conducted within the tripartite agreement.

 

In response to Member questions, the Managing Director of GCCG confirmed that the three partners work very closely to deliver the tripartite agreement.  Circle MSK work very closely with the General Practitioners (GPs) and it was confirmed that commissioners are now in the position to confirm that positive outcomes are being achieved and the GCCG are happy with performance.

 

The General Manager, Long Term Conditions LGT said that L&G NHS Trust has worked with GCCG and Circle from onset and meet with Circle on a weekly basis.  Work is done together to reduce waiting times and track patients through the system.  He outlined that an area of concern had been the drop in activity at the site and that partners will continue to work together to make improvements.

 

The Chief Executive, Healthwatch informed Members that the organisation had been monitoring the implementation and delivery of the new Circle MSK contract.  Healthwatch followed Circle MSK for over a year and Officers had attended contract monitoring meetings, Circle MSK clinical steering groups meetings, had carried out a series of Enter and Views to the Circle MSK Community hub at Eltham hospital and held a series of focus groups to enable MSK patients to share their experiences.  However, it was outlined that the report is based on a small sample size of 65 people.

 

In response to Member questions about the small sample, the Chief Executive, Healthwatch felt that the Circle MSK administration had an adverse impact on numbers responding as Healthwatch fliers were not sent with Circle letters as planned.  

 

In response to Member question about choice and streamlined process and that patients with other needs found it difficult to navigate through the system and were often just given an appointment, the Director of Integrated Care Operations of Circle MSK informed Members that the service has Patient Choice Advisers and also aims to support people in other ways such as offering physio and pain management depending on what is deemed to be the most appropriate pathway.  Circle MSK works collaboratively and in partnership with Lewisham and Greenwich NHS Trust to deliver local care for local people. This means that patients who want surgery and meet the evidence based criteria for surgery will be referred to the consultant directly. Patients whose conditions demonstrates that surgery is not the best option for them will be treated by other non-surgical methods.

 

In response to Member questions about the Hub and Spoke model, the Director of Integrated Care Operations of MSK said that Spokes are developed in areas based on patterns of referral and confirmed that clinicians used triage guidelines to refer patients appropriately.  In line with the treatment access policy, the Director of Integrated Care Operations reiterated, that those patients that wanted surgery and where it is clinically appropriate, were referred to a consultant directly.  Patients were tracked to ensure that the service is getting it right.

 

In response to Member questions about self-help through social prescribing, the Managing Director of GCCG and the Director of Integrated Care OperationsCircle MSK asked Members to let them know of any third sector organisations that they are aware of that provide this support so that they can enhance their contact lists.

 

In response to Member questions about pre-contract pathways outlined in the presentation and how this could be taken out of context, the Director of Integrated Care Operations, Circle MSK informed Members that the model used was based on a particularly the complex [1]worst case scenario and was only used for illustrative purposes.  The service ensures that people make informed choices and a number have a dedicated choice conversation with clinicians to ensure that they are placed on the correct pathway to suit their need.

 

In response to Member questions about reaching out to inform patients of preventative activity, given that evidence suggests early help leads to better outcomes, the Director of Integrated Care Operations, MSK said that self-management information is available on their websites.  Patient literature is also available and it is hoped that this would be further developed to ensure it is accessible by everyone that needs it.  GPs support with this as they have physiotherapists placed within practices and patients can have early access to a physio.  67% of patients that require physiotherapy have waited less than 5 weeks and Circle MSK continues to improve on this.  This is continued work in progress.  

 

In response to Member concerns that 65 people out of an average of 2,000 that are referred to MSK service on a monthly basis had contributed to the work of Healthwatch, and that only 2 people out of the 65 received the leaflet informing them of the work Healthwatch were doing, the Chief Executive, Healthwatch agreed that this is very low return.  He outlined that 3,000 leaflets were printed with the consultation dates and dates of the three focus groups included and were therefore timeframe based.  A large number of leaflets were given to Circle to be sent out by the administration centre at Circle MSK.  For this type of activity, 3-4% response would be the expected minimum, but then only had 2 responses.

 

Circle MSK confirmed that the high-volume of referrals impacted on the administrative arrangements to chase patients for responses. The Chief Executive, Healthwatch assured Members that, although only 65 responses were received, the information received was detailed and demonstrated people’s experiences of the service. The report was based on exactly what they had been told. The Chief Executive, Healthwatch went on to clarify that they are independent, regardless of where the funding comes from, with a clear transparency statement.  No funder or commissioner is able to veto the content of the report.  Although many people were very positive, information gleaned from those that were not, was also presented in the report.  The Managing Director, GCCG expressed that MSK supported this activity and the outcome reflected in the report demonstrates the positive relationship.

 

Members referred to a recommendation that patients wish to receive quality performance data to enable them to make informed choices.  Members felt that services are required to be transparent and how information presented should not be misleading.

 

Given the financial situation that the Trust is in, Members asked for assurances that the triage system would not affect the financial situation of the LGT NHS Trust as they are aware that the funding follows the patient. The General Manager, Long Term Conditions at LGT informed Members that from the Trust’s perspective, one of the key messages that came out was around activity levels and the outpatient levels.  The risk was not from the trauma element.  13-14 orthopaedic clinics are delivered from Eltham and there is no risk to Orthopaedic work force. The financial position is tracked through shared information on activity.  Currently this does not present a risk and there is no lack of economic viability to maintain the Queen Elizabeth Hospital as a full A&E site.  There has not been any need to invoke any clauses in the tripartite agreement.

 

Key performance indicators need to related to contract arrangements and note that this has not been presented today.  The Managing Director of GCCG said that this information can be provided to Members and will include a narrative report to explain these.

ACTION: Managing Director, GCCG.

 

In response to Member question the Director of Integrated Care Operations, Circle MSK said that administrative challenges were caused due to the higher volume of referrals than had been expected.  To ensure that patients were placed on the right pathway for their conditions, regular clinical and administration meetings took place to manage this.  Training was provided where needed to improve the situation. 

 

The Chair agreed to members of the public putting questions to presenting officers.

 

In response to questions by a member of the public, the Managing Director, GCCG said that he would provide information about patients referred to other partners and will include an age breakdown.

ACTION: Managing Director, GCCG

 

In response to a question from a member of the public, the Chief Executive, Healthwatch took on board that the views of 65 people are not too many.  The Managing Director, GCCG said that there was no reason that another survey could not be commissioned to take place further along the contract period to gain the views of people that either have completed their treatment or are nearing the end of the pathway.

 

In response to a question by a member of the public, the Managing Director, GCCG said that prior to Circle MSK taking up this contract, activity was known and that there were many pathways for patients.  Without the existence of a hub, a triage service at that time was not available and GP’s could refer patients to a number of providers.  The Managing Director, GCCG said that data could be provided to show where referrals were made to, but they were unable to provide information on the range of pathways that occurred for patients.

ACTION: Managing Director, GCCG

 

The illustrative nature of the Pathways outlined in the presentation, showed the need to have a triage service in place that would streamline the process and reduce the ‘bouncing’ of patients from GP’s and services.

 

In response to a Member question, the Director of Integrated Care Operations, Circle MSK will provide information on the number of healthcare workers that are employed by them directly.

ACTION: Director of Integrated Care Operations, Circle MSK.

 

The Chair agreed to members of the public putting questions to presenting officers.

 

In response to a question by a member of the public, the Director of Integrated Care Operations, Circle MSK said that they recognise that the internet does not work for everybody and they have looked at other ways of engagement.

 

In response to remarks made by the Cabinet Member for Adult Social Care, Health and Anti-Poverty the Director of Integrated Care Operations, Circle MSK said that 66% of patients are seen by Lewisham and Greenwich NHS Trust because patients choose services based on waiting times and that patients with specific needs linked to spinal issues would need to go to other providers and this fluctuates seasonally.  She said that Circle MSK are continuously looking to improve services and welcomes scrutiny intervention in achieving this.

 

The Chair ended the discussion by reminding Officers that Scrutiny would like to see dashboard performance reporting based on contract targets and information on demographics to be included in future reports.  Information about percentage of patients going for treatment elsewhere with an explanation of shift in activity to be included.

ACTION: Director of Integrated Care Operations, Circle MSK, Managing Director, GCCG and L&G NHS Trust.

 

Resolved –

 

The presentation be noted.



[1] Amended at the meeting of the Healthier Communities and Adult Social Care Scrutiny Panel on 1 November 2018

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