Allied Health Professional Musculoskeletal Pathway Minimum Standards: A Framework for Action 2015-2016

Executive Summary

1. Purpose

The purpose of this document is to provide a minimum standard for Allied Health Professionals (AHPs) musculoskeletal service delivery. The work aims to support the national musculoskeletal redesign work streams in enhancing musculoskeletal services and reducing unnecessary variation for service users and staff in the National Health Service (NHS) Scotland.

2. Background

Musculoskeletal conditions are one of the most common causes of severe long-term pain and disability in Europe and lead to significant Healthcare and social support costs. As a major cause of work absence and incapacity they also have a major economic cost through lost productivity^[3]. Recent times have seen increasing pressure on musculoskeletal and orthopaedic services to adapt and change to meet various external and internal pressures, which include amongst others demographic changes, increasing service user demand, advancements in technology, socioeconomic changes, drives to maximise healthcare efficiency and improve service quality, employment law and contractual alterations and changes in historical professional boundaries.

3. Situation

Policy makers have searched for innovative ways to try and cope with the increasing demand for musculoskeletal services. While the intent of many of these innovations have been admirable they have often historically been introduced in an inequitable manner, leading to widespread unnecessary national variation between health boards and even within the same health board. Reasons for this variation arguably include differences in historical investment in musculoskeletal services, management structures, skill mix, facilities, geography, socioeconomic factors, local innovations, previous local service prioritisation, variation in the local availability of orthopaedic specialties and links with tertiary services.

The key aims of the current orthopaedic and AHP musculoskeletal redesign programmes, for example Transforming Outpatient Services and the 4 Week Rapid Access to AHP Musculoskeletal Services, is to establish musculoskeletal services that provide person-centred, equitable and seamless musculoskeletal management pathways for all service users.

4. Objectives

The objective of this document is to initiate a process to reduce unnecessary variation between health boards in the provision of musculoskeletal care and act as catalyst for further discussion for future enhancements. It does not provide advice about the management of specific musculoskeletal conditions.

5. Recommendations

The focus of the document is on AHP Services, however, given that musculoskeletal services should provide a seamless pathway for service users then the framework details the interface requirements both into and out of AHP services. The standards outlined are:

First Contact Considerations (GP or Other Suitably Qualified Healthcare Professional)
Standard A Screen for Serious Pathology Indicators (Red Flags)
Standard B Consistent Advice from all Contact Points Utilising NHS Inform Resources
Standard C Medication/Analgesia as Appropriate
Standard D Appropriate Investigations
Standard E Equal Opportunities to Access MSK Pathways via Self or Healthcare Professional Referral

Routine AHP Service Provision
Standard F NHS Board Working to Current National Waiting Time Targets
Standard G Appropriate Use of Different Modes of Clinical Consultations
Standard H Management Plan Discussed and Agreed as per Pathways

Potential Onward Referral Work Up
Standard I Clinical Supervision Framework with Case Review Policy
Standard J MSK Service Access to Investigations as Appropriate
Standard K Process for Onward Referral

6. Conclusions

The outlining and implementation of these standards is only one step in improving musculoskeletal care in Scotland. It is hoped that the framework will stimulate debate and evolve as the national musculoskeletal redesign programme progresses in the coming years.