Personalised Approaches in MSK

Background 

We began working with colleagues in the hip and knee pathway when Virtual Clinics were being rolled out. These clinics were designed to enable a conversation between a First Contact Pracitioner (FCP) a hip/knee Consultant and a person with a potential replacement need. This new way of working reduced people's travel time and helped to speed up the process of listing people for surgery but not everybody with joint pain ends up having an opperation, so what happens...?

We began by looking at the pathway from the point of the person. Starting with "Ouch my knee hurts" right through to recovery from surgery. We did a system review looking at the individual, the social environment around them, the organisations that they interact with, the physical spaces that they visit and also the policies / procedures that impact their journey. Colleagues from multiple organisations mapped the journey and began to highlight touchpoints where personalised approaches could be embedded. We then surveyed the workforce to better understand their exsisting levels of knowledge and confidence in these approaches, our tools/resources and training opportunities. 

A similar activity took place with people. Facilitated by our co-production partners, Every-One, people with lived experience of the hip/knee surgical pathway met with physios, occupational therapists and managers and collectively shared their experiences, concerns and unanswered questions. Their frustrations helped to spur us on! 

So what did we do?

Armed with our increased knowledge and understanding, we began to focus our efforts in to four key areas. These ambitions continue to guide the work of a small Task and Finish group of representatives from across the system. 

We continue to see improvements to website content so that people can be signposted to suitable resources by our workforce colleagues and likewise our staff are more knowledgeable about the products and services that are out there. 

People are sharing their stories and the information is being used to shape approaches such as prehab classes and self-management opportunities. New literature is produced that 'talks' to the MSK cohort in a way that makes the services feel appropriate and accessible.

We coordinated a community-based Aches and Pains Hub as a way of challenging MSK delivery partners to think differently about their usual practice. This activity brought all aspects of the system together in an integrated way within one space. 

Staff teams have been trained on the use of Decision Support Tools and continuous advoaction of them is enabling more colleagues to hear about their uses. Likewise, there is an increased knowledge of partnership opportunities with commissioned services getting their activities to the people that need them most. 

Recording systems are being developed to report on things such as Patient Activiation Levels, if Shared Decision Making conversations are taking place and what resources are being given out to support self-management. These datasets help managers to measure their services and audit for success. 

There is plenty more work to do before personalisation is embedded, however, we are continuing to support colleagues to achieve the goals and are able to demonstrate some of the impact that we are supporting them to make.

Check out the news section for articles relating to our work in MSK.

For more information: matthew.evans34@nhs.net