By Accountable Care Journal-
Newham, a borough in East London coterminous with Newham CCG, is one of the most ethnically diverse in the capital. Every ward in Newham is ranked within the most deprived quintile nationally. This was the backdrop to the challenging transformation of fully integrating MSK services.
The CCG Board asked for a review of musculoskeletal (MSK) services. It wanted a blueprint for a revised service specification providing for a clinical pathway that is fully integrated across hospital and primary care services rather than fragmented with multiple entry points and service duplication. STO Healthcare, a core member of The Network, utilised its model of Structured Collaboration to assist with delivery.
This required a process that identified and brought together all existing service providers with the aim of facilitating real collaboration around design both clinically and commercially, as well as the establishment of a single entity that manages patients, marshals a full budget plan, and runs all of the service pathways for the identified cohort.
What happened in Newham?
The unique structured collaboration methodology mobilised Newham’s existing providers to collaborate, design and deliver an MSK integrated service using a prime provider model. Through this process framework, the Newham providers, all of whom held a current commissioning contract with the CCG, worked together to deliver an integrated, safe and efficient patient focussed pathway, the commercial arrangements that bound the collaborative providers together being the responsibility of the provider group.
As part of the Structured Collaboration model for MSK redesign, the CCG held a series of subject-specific workshops with the collaborating providers, designed and crafted by STO Healthcare to produce specific outcomes over a defined time period. Through design and challenge facilitated discussions, the model for delivery of the CCG vision began to emerge. The STO team worked closely with the Newham commissioner and providers, between workshops, to ensure the progress against the overall delivery of the Structured Collaboration approach met the milestone Progress Review Gateways for both the CCG’s and providers boards.
What was the impact?
As well as delivering an integrated service, the resulting blueprint for redesign ensured improvements for patients, a more efficient and coherent use of resources and clear deliverable outcomes.
The benefits of true integration mean increased simplicity and clarity for patients and a significant reduction in duplication, inefficiency, and waste for providers. The new MSK service facilitates an inter-disciplinary team approach to care that allows treatment to be delivered in a more streamlined way.
The service encompasses all elective aspects of MSK care, from secondary care treatments within a hospital setting to those conducted in the community. Other key aspects and expected developments of the model include; preventative interventions across the pathway, access into MSK services for all patients via a Hub, a single contract and capitation-based budget, an MDT based service to ensure coordinated coherent care, increased focus in the early part of the pathway and community-based interventions. They also include the interesting development of a non-tariff based capitated payment system.
There were six core expected MSK outcomes observed from the integration transformation in Newham:
- Prevention - preventing years of life lost to disability to MSK conditions and improving Quality of Life for service users
- Patient experience - ensuring patients have a positive experience of care and are enabled to recover or to manage their condition
- Quality - ensuring quality in service provision for people with MSK conditions
- Governance - achieving financial stability and ensuring accuracy in activity reporting
- Innovation and Integration - ensuing innovation in service delivery and integration of services provided to people with MSK conditions
- Professional Development - ensuring education and advice is available to the professional workforce and developing a culture of learning.
Network member, STO Healthcare contact: Tony Carpenter: firstname.lastname@example.org tel: 07779 236851