Pennine MSK Partnership Ltd

Clinically-led integrated musculoskeletal services

  • - 58% reduction in mean waiting time for first outpatient appointment

The integrated, primary care based musculoskeletal service delivers rapid access to care, and works closely with the clinical commissioning group (CCG) and local community to reduce health inequalities and improve access for hard-to-reach groups.

Download a printable pdf of the Pennine MSK Partership case study

The challenge

  • - Primary care clinicians identified a trend of disinvestment in musculoskeletal services provided by the local secondary care providers
  • - Service capacity could not meet demand and waiting times were increasing

The solution

  • - Pennine MSK Partnership, working with the CCG, implemented a programme budget approach for the MSK pathway
  • - The service covers a diverse population, including high numbers of ethnic minorities and asylum seekers, and is delivered through a population-based approach to MSK care, working closely with the CCG and the local community
  • - The service aims to deliver better value through evidence-based, NICE-compliant care
  • - Referrals are taken from general practice, who choose and book the service, as well as physiotherapists, podiatrists and the OUT clinic

The service profile

  • - The service is community-based across several sites with well-established relationships with other co-located providers
  • - New patients are triaged within 24 hours to identify the appropriate pathway, and assessed within 1-3 weeks for onward consultant management within 1-2 weeks
  • - Treat to target therapies delivered by nurse-led pathways facilitate shared decision making, appropriate escalation to DMARDS, flare management and access to biologic drugs for those eligible
  • - Home administration service for subcutaneous biologics drugs and an infusion service for intravenous biologic therapies (treated as day cases by previous providers)
  • - Rapid access to the MDT as well as psychological medicine with annual review
  • - Telephone advice along with self-management programmes with Arthritis Care and NRAS
  • - The service provides support and education for general practice
  • - Links with secondary care are well-developed, enabling rapid access to beds where appropriate

Service performance and outcomes

  • - Mean waiting time from referral to first outpatient appointment has been reduced from 45 days to 19 days
  • - 69% of patients have DAS-28 score performed every 4-6 weeks (compared to 31% previously)

Patient focus and satisfaction

  • - Patients are increasingly empowered through shared decision making
  • - Once referred, patients have direct access to services via self-referral and advice line provision
  • - A customer care manager gathers, collates and acts upon compliments, complaints and criticisms
  • - 100 randomly selected patients are surveyed each month to measure patient satisfaction
  • - 96% of those surveyed recently stated they were either completely satisfied or satisfied
  • - The service has been awarded the Customer Service Excellence award annually by the Cabinet Office 2008-2013. It has met all standards set by the Care Quality Commission who noted that patient views and experiences are taken into account in service provision

Financial performance

  • - Per capita musculoskeletal spend in the area has fallen by 10% during the period of the Partnership’s existence

Commissioning priorities

The Pennine Musculoskeletal Partnership is an example of commissioning best practice in rheumatology and meets a number of the priorities for commissioners as outlined by the King’s Fund in 2013:
  • - Active support for self-management – patients with low self-efficacy are targeted and offered a place on a programme to improve their skills in self-management
  • - Secondary prevention – rapid triage and early assessment helps to quickly control disease activity and prevent patients’ disease from worsening
  • - Care co-ordination – nurse-led care helps patients to access all services provided by Pennine MSK appropriately
  • - Medicines management – treat to target therapies delivered by nurse led pathways facilitate, appropriate escalation to DMARDS, flare management and access to biologic drugs for those eligible

Sponsorship statement

This best practice case study project has been sponsored by UCB and supported by a medical education grant from Pfizer.
UCB and Pfizer have not had any influence over content: editorial control remained with the British Society of Rheumatology.

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We gratefully acknowledge the generous support of our sponsors, which enabled the case study project to take place.