Reducing health inequalities in musculoskeletal conditions
NHS Leicester City and NHS Leicestershire County and Rutland serve a diverse population of around one million people. With an ageing population locally, the Leicester, Leicestershire and Rutland Planned Care Board identified musculoskeletal conditions as an area of high priority, with variations in care pathways and patient outcomes. Audits of individual patients’ case notes identified that much of the variation in care arose from a lack of consistent access to support services such as Orthotics or Physiotherapy, and a lack of consensus about expected pathways of care. The Trusts wanted to reduce health inequalities and standardise access to care by producing a set of local pathways that would clearly define referral guidance and enhance the quality and efficiency of services.
A group of some 50 clinicians from primary and secondary care (including GPs, Consultants and Allied Health Professionals) developed a comprehensive set of local Musculoskeletal Referral Guidelines, drawing upon the relevant pathways and information contained in the Map of Medicine pages and other sources. The local pathways were then reviewed and approved by local primary and secondary care organisations prior to publication on the Map of Medicine.
Role of Map of Medicine
In discussion with local clinicians about developing pathways for musculoskeletal conditions, the Map of Medicine was identified as providing an effective tool for disseminating pathways electronically, as well as being an easy way to ensure users could always refer to the latest evidence-based practice. GPs were also keen on using the Map as a single repository for local information (for example, contact numbers for local providers) as well as other resources such as patient information leaflets.
Challenges
Reaching clinical consensus on the content of the referral guidelines was relatively straightforward; more challenging was the communications work to promote them to GPs as a tool for ensuring quality, equity and efficiency. The Map of Medicine provided an effective vehicle to make the guidelines universally available to clinicians in the area, whilst the clinical leads demonstrated the benefits to patients, referrers and providers of following standardised pathways of care. In making the case for using the guidelines, the health community’s challenge is to keep the level and provision of services under review, to ensure that local services are available and configured to enable clinicians to comply with the pathways.
Anticipated Results
A baseline audit suggested that by implementing standard local pathways, the Trusts could expect up to 4150 fewer first Orthopaedic outpatient appointments across the region; and improved quality and equity for patients who are directed to the right place, first time. Clinicians now have access to locally agreed and validated pathways on the Map of Medicine that represent appropriate and efficient care; waiting time pressures on providers will reduce as avoidable referrals drop, freeing up clinical time to focus on providing timely, equitable and high quality care for the benefit of patients in Leicester, Leicestershire and Rutland.