GP update on MSK provision by Healthshare.

We are conscious that there have been questions raised about some aspects of the new MSK service. This update will address these questions particularly around imaging requests, Rheumatology appointments, and the arrangement of physiotherapy, the Pain clinic and consultant to consultant referrals.

  1. MSK Diagnostic requests.

With the new Healthshare MATT service there has been a lot of correspondence about GP’s access to imaging as part of their patient’s clinical pathway.

1.1.Plain x-rays

These can be ordered by GPs through ICE as previously.

1.2 Limited MRI lumbar spine (to exclude malignancy and infection)

GPs order through ICE as previously.Some MRI scans are listed on ICE as ‘limited access’ e.g. for thoracic spine and can be ordered after discussion with the Radiologist via e-mail as indicated on ICE

1.3 MRI knees:

For patients less than 55 MRI can be ordered on ICE .

For patients over 55 (with normal plain film): patients where it is felt the clinical pathway may include the need for MRI should be referred to Healthshare. They will assess the patient, organise the imaging where needed, act on the results and either treat the patient or refer on to secondary care .The same is true of full MRI of the lumbar spine.

The Notable exceptions are MRI scans for potential bone malignancy which should be organised as part of the 2ww pathway.

1.4 MSK Ultrasound

If MSK ultrasound is indicated as part of a clinical pathway the patient should be referred to Healthshare. They will assess the patient, arrange the imaging where needed, act on the results and either treat the patient or refer on to secondary care where appropriate.

If a GP wants to order a MSK ultrasound refer to the independent provider (currently Global). Do not refer to OUH for MSK ultrasounds.

As part of the clinical pathway for patients referred to them, Healthshare will arrange a range of diagnostics including plain x-ray, MRI, and ultrasound imaging, act on the result and treat the patients.

GPs do not need to arrange imaging for patients seen by Healthshare clinicians as they have access to imaging (currently using paper requests to be available soon via ICE).

1.4 Non MSK ultrasound

Ultrasound scans for lumps and bumps should be requested on ICE as previously and marked ‘non MSK’

  1. Cauda Equina

Referrals for potential cauda-equine should not be for urgent imaging but urgent referral to Hospital; during the day (0800 – 1600) to the orthopaedic registrar on call at the NOC and out of hours via A&E.

GP refers to the Orthopaedic On-call service. (0800 – 1600)

  • Telephone switchboard: 01865 234560
  • Ask for Orthopaedic Registrar On-call: Bleep 404

If clinically appropriate the Orthopaedic On-call will contact the Spinal Fellow On-Call

These referrals should not go through Healthshare.

  1. Rheumatology

3.1 Urgent Rheumatology pathway

The GP should call the Rheumatology registrar on call via the OUH switchboard, start the steroids according to advice given, a referral letter should be emailed directly to Rheumatology () with a copy emailed to Healthshare() indicating that the rheumatologists have arranged the appointment.

. The registrar will arrange the urgent appointment in clinic

3.2 Temporal arteritis pathway

For the GCA pathway GP’s should call the Rheumatology Registrar on call , start the steroids according to advice given, a referral letter should be emailed directly to Rheumatology () with a copy emailed to Healthshare () indicating that the rheumatologists have arranged the appointment.

. The registrar will arrange the urgent appointment in the GCA clinic.

3.3Metabolic bone unit referrals

These referrals should go through Healthshare.

  1. Community physiotherapy

Where a patient is seen in a secondary care MSK clinic (including Rheumatology) and it is felt that the patient needs community physio this should be arranged by the Consultant or their team through Healthshare. GP’s should not arrange these appointments or be expected to refer for them.

  1. Pain Clinic

Referrals for the Pain clinic should be referred through Healthshare either directly by the GP or if a secondary care clinician believes the referral is appropriate by them through Healthshare. These should not go back to the GP to refer on.

  1. Consultant referrals

Patients who are seen in one MSK speciality and an onward referral to another MSK speciality is required (including the pain clinic), should be referred by secondary care via Healthshare. These should not go back to the GP to refer on.

  1. Consultant to Consultant referrals.

With the exception of emergencies and potential malignancies referral to any musculoskeletal speciality from a secondary care clinician should be via Healthshare.

  1. Communication with patients from Healthshare following GP referral.

All referrals are paper triaged upon receipt, within 48 hours (90% of the time). The patient may then have a face to face assessment or be referred directly for treatment. Healthshare send text messages for those patients with a mobile phone or a letter if not, within 48 hours of the paper triage. The waits are broadly similar across the county; around 10-12 weeks for physiotherapy with a plan to reduce that over the next 4-5 months to 2-4 weeks. See below for more detail.

There has been useful feedback on the letter sent out to patients and as a result Healthshare have made changes to reflect the comments received to ensure it is more easily understood. The letter and wait times are attached below

To contact Healthshare with any queries use:

Email:

Call: 01865 238108

<Today's date>

HEALTHSHARE WELCOME

Dear <Patient Name>

Welcome to Healthshare MATT (Musculoskeletal Triage and Treat) / Physiotherapy/ MSK Podiatry Service.

What will happen next?

Your referral will be reviewed by an appropriate member of our clinical team and we will arrange for the next stage in your care. This could be any of the following options depending on the referral information provided.

An appointment with an appropriate physiotherapist or podiatrist for treatment

An appointment with an expert for an assessment (this could include an ultrasound/ injection or referral for an x-ray or MRI scan if required)

A referral to another service if the problem you have been referred for is not something we treat within Healthshare.

How will you know what is going to happen?

If you have a mobile phone number on your records we will text you in the first instance, alternatively we will send you a letter explaining the next stage of your care.

What do you do if no-one contacts you?

Please call the MATT Physiotherapy & Podiatry Service on 01865 238108 and one of our advisors will be able to help you.

How long will this take?

That depends on what you were referred for. The waiting times for different types of treatment options vary, for example, if our experts decide you need to see a Consultant Surgeon then you will be sent paperwork with a range of choices within 2 weeks, your wait time will be dependent on the hospital or service you have chosen and is not influenced by Healthshare. If you need to see a physiotherapist or podiatrist you will hear from us approximately 4 weeks before you are due to book your appointment. For more detailed information regarding our wait times please see overleaf.

You do not need to take any action following this letter and we thank you for your patience.

Yours sincerely

Healthshare Oxfordshire Administration Team

CURRENT WAIT TIMES

Service / Wait time * / Information
Physiotherapy / 10 – 12 weeks / Routine physiotherapy for most musculoskeletal conditions and you will be contacted 4 weeks before you need to book your appointment
Specialist Physiotherapy / 8 – 10 weeks / Specialist physiotherapy may include needing to see a specific person who has a special interest in your condition and can provide the best treatment options. You will be contacted 4 weeks before you are due to book your appointment.
MSK Podiatry/ Orthotics / 12 weeks / This is for podiatry relating to the muscles and bones in your feet only and you will be contacted 4 weeks before you need to book your appointment
Ultrasound only / 6 weeks / Global Diagnostics will contact you when they get your referral (usually within 2 weeks).
MATT Assessment / 16 weeks / This could include an ultrasound and/or injection and you will be contacted 4 weeks before you need to book your appointment
Exercise Classes / 3 weeks / This is usually a 6 week rehabilitation programme and you will be contacted 2 weeks before you need to book your appointments.
PGP Classes (Pelvic Girdle Pain for pregnancy) / Classes are currently run twice monthly and this increases depending on demand / When we receive your referral we will let you know when the next class is running and you will be able to book your appointment.

*It is important to note that these wait times are subject to location and there may be appointments available sooner at other locations if you are able/ prepared to travel to another clinic to attend an appointment. Any referral deemed Urgent will be seen within 2 weeks.