Musculoskeletal Clinical assessment and Treatment Service (MSK CATS)

The professionalism and ambitious breadth of work in a holistic and systemic approach were just some of the qualities in theBoltonentry that stood out for the judges. The panel also appreciated the strong focus on quality, an evidence-based methodology and robust outcome measures that delivered sound and tangible results. The provision is highly valued by patients, successfully engages them in shared care and responds to their needs in a timely manner. The judges were left with the impression that this was a model service.

The innovative MSK CATS reduces the patient journey time in orthopaedic services, is a Bolton PCT flagship and was chosen by the Dept of Health as a Care Closer to Home national demonstration site.

Recognising that people with musculoskeletal conditions seek wide-ranging prompt and convenient support and treatment the vision of MSK CATS embraces both Orthopaedic and Rheumatology services, reducing the time surgeons spend at out patient clinics, providing clinically and cost effective pathways.

The new integrated service is based on guidance within the MSK service framework to plan and design care around patient needs. It is a one-stop shop in the town-centre delivering care closer to the patient’s home

Support for primary care clinicians provides an evidence base for referral and timely booking and choice. The daily triage service is managed by senior specialist clinicians, deflects appropriate referrals and allows for planning for first stage diagnostics according to protocol.

Assessment at the centre takes account of objective clinical input and the patients own subjective story. Diagnostics are performed on the day of this appointment. If the patient is to be treated at the centre by members of the CATS MDT, a clinical management plan is agreed with them that can start within 4 weeks. A ‘fit for surgery’ nurse specialist assesses and prepares patients referred to secondary care.

Janet Edwards Assistant director of adult services

Highly Commended The League Practice Based Commissioning Consortium

Acute Visiting Scheme

The League needed an innovative ‘quick-win’ value for money project to gain the confidence and clinical engagement of GPs and simultaneous PCT approval.

The ‘Acute Visit Scheme’ responded to an issue needing prompt attention - the high numbers of hospital admissions resulting from acute visit requests to GPs while in routine surgery - and fulfilled these criteria.

The objective was to reduce unscheduled hospital admissions by getting these patients seen within 60 minutes. GPs used a standard form to triage and refer into the schemes specially recruited ‘floating’ GP.

Of the services 370 visits in its first six months, only 4 resulted in hospital admissions, a rate of 1 per cent compared to 5 per cent when patient’s were visited by their own GP.

Surgery access for patients has also increased. Each scheme visit releases approximately 30 minutes or 3 additional GP appointments. Significant savings to the
PCT unscheduled care budget have also been achieved.

Judges commended the clinical and financial impact of the work of The League and its achievements in gaining high levels of both GP and patient satisfaction.

Dr Shikha Pitalia GP and Chair of The League

Highly CommendedYeovilDistrictHospitalNHS Foundation Trust

Access - TheYeovil Way

YeovilDistrictHospitalhas become the first trust to achieve 18 week waiting times, a full 21 months ahead of the December 2008 target. All the more remarkable given that in March 2004 waiting times were at 20 weeks for a first outpatient appointment and 26 weeks for an inpatient procedure.

To improve the patients’ experience and restore the trust of consultant medical staff trust that patients would not be cancelled at the last moment workstreams were set up to examine bed days reduction, radiology access, cancelled operations and 18 weeks.

Eliminating or reducing parts of the emergency pathway that did not add value have cut ‘bed crisis’ days for period October to March 2006/07 to 8, the imaging department scored the highest HC diagnostic review marks in the country and MRSA bacteraemia cases dropped to below 12 in 2006/7.

Learning from Yeovil is spreading nationally and the trust was commended for its achievements. Leading and acting on patient the experience in an active way particularly stood out for the judges, as did service improvement methodologies to develop new and flexible roles.

Pat Jenkins, Director of Operations,

TorbayCare Trust andDevonPCT

South DevonPractice Support Team 'Delivering Patient Choice at Point of Referral'

TheSouth DevonPractice Support Team - developed to deliver patient choice at the point of referral - have succeeded in rolling out Choose and Book, Patient Choice, Electronic Prescribing and GP IT Support.

In one of the highest performing areas in the country for Choose and Book, the approach used by the Team in South Devon is now being rolled out across all of the 107 practices within the new Devon PCT.

Karen Barry, Programme Manager,

Cambridgeshire PCT and Cambridge University Hospitals NHS Foundation Trust

Improving Access to Diagnostics & Specialists to Reduce Admission

Joint working between primary and secondary care has identified opportunities for increased out of hospital care. A new Emergency Department (A&E) has revolutionised emergency patient access to diagnostics and specialist opinions and significantly reduced admissions.

Emergency Department patients are subject to the Four Hour Target, including GP referrals – 39.5% of which are now discharged without admitting. Waits for tests, investigations or opinions for management plans are also shorter.

Anna Gillard, Head of Unplanned Care

Hammersmith Hospitals NHS Trust

ZERO waits for all imaging!

Hammersmith believe that no unnecessary wait for imaging is acceptable - and that zero waits is both a wholly realistic goal and fundamental to a decent hospital service. Following sustained effort over the last 12 months this has been achieved for X-rays, ultrasound and bone density scanning. Routine MRI waits are down to 11 days and CT waits to just 5 days, with the planned trajectory reaching zero waits before December 2007.

Professor Philip Gishen (Clinical Director, Imaging)