MSK - New MATT Service – Healthshare Oxfordshire

FAQs

  1. What is the process for requesting diagnostics?

a)MSK diagnostic requests

MSK diagnostics are to be requested through Healthshare under the new Musculoskeletal assessment, triage, and treatment (MATT) service for Oxfordshire. All diagnostics should be requested using the new pro-forma. Healthshare will act as a ‘one stop shop’ type service as they will be ordering diagnostics interpreting the report and arranging for on-going treatment without the need for the patient to go back to the GP. Healthshare will either carry out treatment themselves (physiotherapy, injections etc) or refer onto secondary care if more specialist treatment / surgery is needed. Referrals to secondary care will fall in line with lavender stated guidelines. This is a model which many GPs requested as part of the development.

There will be no change for GPs that perform joint injections. Referral to Healthshare is required if ultrasound diagnostic is required prior to injection or ultrasound guided injection is required.

Healthshare are currently establishing diagnostic provision both in the community and secondary care.

b)Non MSK diagnostic requests

Non-MSK ultrasound referrals e.g. lumps and bumps, should continue to be requested on ICE for a referral to secondary care. We appreciate that there has been some confusion around this and apologise for the time it has taken to resolve some of the rejection issues that have occurred.

Access to X-RAY and other diagnostics have not changed.

a)Suspected cancer 2ww

To ensure compliance with NICE Guidelines for suspected cancer, OUH will continue to accept direct access urgent ultrasound requests (to be performed within 2 weeks of referral) to exclude soft tissue sarcoma, in adults with an unexplained lump that is increasing in size. Please ensure appropriate clinical details are provided to allow these to be identified.

  1. Will Healthshare contact patients that had appointments booked (and cancelled) by the previous providers?

Yes. Healthshare are processing notes from the previous providers. Due to the nature of the notes transfer this is taking longer than expected.

Healthshare has a backlog of approximately 12,000 patients waiting to be seen. These are divided into 3 groups, and will be prioritised as follows:

i)Any patient mid-way through treatment

ii)Patients that have been referred by a GP, allocated an appointment by the previous provider which was cancelled by the previous provider prior to transfer.

iii)New patients that have been referred, but not yet received an appointment. (Those patients waiting the longest will be prioritised).

Please reassure patients that Healthshare will be in contact to re-book their appointment as soon as possible, this may take a few weeks but they have not been forgotten or lost their place in the ‘queue’.

This is a very complicated piece of transformation work as well as a large patient cohort transition. Please bear with us while processes get settled in. If you would like to discuss the service, or have any queries for Healthshare, please contact them via this email can also be given to patients. They are keen to work with Oxfordshire clinicians to enable the delivery of the best possible community service to the population of Oxfordshire.

Queries from GPs can also be directed to the CCG via the planned care team email address

a) Requests to re- refer patients

Unfortunately patients that were referred for physiotherapy during the changeover but had not been booked on the choose and book system needed to be re-referred as their referral wasn’t available to transfer.

This should be a small number of patients all of whom should now have been notified .

b)How long will it take Healthshare to respond?

Healthshare will respond to queries and provide ‘read receipts’ to all new referrals within 5 working days.

Last week (w/c 2nd October) response times were longer due to training of new staff to the service. This has now been resolved.

All referrals are triaged and urgent patients are being allocated to clinics. Urgent patient clinics started on 6th October.

  1. What is the E-Referral Process?

As per previous communication through the GP bulletin, Referral into the MATT service is now via e-referral and the completion of a pro-forma. The process of referring via e-referral was following a direct request from GPs to refer in this way. The process for referring via e-referral will be described on the next iteration of the pro-forma but is this;

Referrals are made in the usual way by searching for the patient and using the refer/advice option found on the right hand side of the patient record.

You can then begin by selecting the appropriate speciality, for example Orthopaedics and then clinic type or Physiotherapy and then clinic type that you would like to refer for.

Once you have selected the appropriate service please book a telephone assessment which allows Healthshare MATT Service to see your “booking” and when you have attached your referral documents we have everything we need to process your referral.

This is an internal process and NOT a real appointment.Please do not take any note of the date or time of this, and please DO NOT give this information to the patient. Healthshare will contact the patient to arrange an appointment.

You will be familiar with this as you have used the process similarly in other services. It is also clearly stated in e-Referrals (previously known as Choose & Book) as can be seen below:

The e-Referral Service has a very detailed Help section which can be found in the top left hand corner, alternatively you can contact the Healthshare Administration team on 01865 238108 for assistance. All referrals must be on the new pro-forma which can be downloaded via this link

Please can you ensure that information regarding BMI and smoking cessation is included on the referral, so that the referrals can be triaged appropriately and referred on and accepted without delay. If you want an MSK Ix/diagnosis/treatment then use the MATT (USS, X-ray, MRI), if you want a non msk ultrasound ( lumps and bumps ) please mark the imaging request ' non MSK '

A comprehensive list of Healthshare e-Referral options for specialty and clinic type can be seen below:

Speciality / Clinic Type / Service Name
Physiotherapy / Musculoskeletal / Healthshare Oxfordshire - MSK Physiotherapy Service
Pain Management / Pain Management / Healthshare Oxfordshire - MSK Pain Management Service
Rheumatology / Bone / Osteoprosis / Healthshare Oxfordshire - Rheumatology Service
Inflammatory Arthritis
Musculoskeletal
Other Autoimmune Rheumatic Disease
Spinal Disorders
Orthopaedics / Foot and Ankle / Healthshare Oxfordshire - MSK Orthopaedic MATT Service
Hand and Wrist
Hip
Knee
Limb Deformity/ Reconstruction
Podiatric Surgery
Shoulder and Elbow
Spine - Back Pain (not scoliosis/ Deform)
Spine - Neck Pain
Spine - Scoliosis and Deformity
Sports Trauma
Podiatry / Biomechanical / Healthshare Oxfordshire - MSK Podiatry/ Orthotic Service
Womens Health / Gynaecological Physiotherapy / Healthshare Oxfordshire - MSK Womens Health Service

Completion of referral pro-forma (Especially those that require referral to secondary care):

When referring onto Secondary care, Healthshare need to ensure they are complying with the Lavender statements. We are looking to modify the pro-forma to include some tick boxes to cover this off for you but in the meantime we thought it would be helpful to clarify the information that needs to be on an orthopaedic referral for potential joint replacement surgery to meet the lavender statement criteria.

The referral should state that;

  • Patients have been given appropriate information including advice about activity and exercise,
  • Intervention to achieve weight loss has been offered, (All patients with a BMI >25 must be offered and encouraged to participate in a weight loss programme)
  • Conservative treatment has been tried for at least 3 months

Where this information is not part of the referral letter Healthshare will have to delay the referral and contact GPs to verify that this has been done so that the referral can proceed.

  1. Where are Healthshare Oxfordshire providing services?

Healthshare are offering their services from a number of locations around the county. They have tried as far as possible to keep the staff in the similar locations to allow patients to receive continuity of care. The locations for the service are:

  • East Oxford Health Centre
    2 Manzil Way
    Oxford
    Oxfordshire
    OX4 1GE
  • Bicester Community Hospital
    Piggy Lane
    Bicester
    Oxfordshire
    OX26 6HT
  • Chipping Norton Health Centre
    Russell Way
    Chipping Norton
    Oxfordshire
    OX7 5FA
  • Deer Park Medical Centre
    6 Edington Square
    Witney
    Oxfordshire
    OX28 5YT
  • Horton Treatment Centre (Ramsay Hospital)
    Oxford Road
    Banbury
    Oxfordshire
    OX16 9FG
  • Townlands Hospital
    York Road
    Henley-on-Thames
    Oxfordshire
    RG9 2EB
  • Wallingford Community Hospital
    Reading Road
    Wallingford

Oxfordshire
OX10 9DU

  • White Horse Medical Practice
    Volunteer Way
    Faringdon
    Oxfordshire
    SN7 7YU
  • Woodlands Medical Centre
    Woodlands Road
    Didcot
    Oxfordshire
    OX11 0BB

The above locations are for service mobilisation. Location of services are under review.

  1. What public engagementhas there been in the development of the model?

OCCG was required to develop a commissioning strategy for an MSK service to meet patient needs, which was efficient and provided a quality service across Oxfordshire. It needed input and engagement from patients, the public and clinicians to develop this new model of care.

A programme of engagement was undertaken including thee following activities:

  • Formation of a patient advisory group
  • Formation of clinical advisory group
  • A joint patient, clinician and stakeholder group
  • Co-design events to gather feedback on the type, range and standard of services people in Oxfordshire would like to see provided
  • Experience Based Co-Design (EBCD) to inform the co-design workshops and a public survey

Below outlines a summary of the engagement which took place in 2014 and 2015:

  • Stakeholders’ event 25 November 2014 ‘process changes’
  • Stakeholders’ event 13 January 2015 ‘improving patient
  • Stakeholders’ event 3 February 2015 ‘developing the service model’
  • Liaison with other CCGs, voluntary organisations and local authorities

Reports on the engagement programme and developing model of care went to:

  • Oxfordshire Joint Health Overview & Scrutiny Committee (OJHOSC) – June 2014
  • Local Medical Committee - July 2014
  • OJHOSC Paper - October 2014

Full details of all the engagement activity, including group memberships, analysis of feedback and data and concluding reports can be found on OCCG’s patient involvement platform Talking Health.

  1. Privatisation of NHS

Oxfordshire Clinical Commissioning Group (OCCG) went out to tender for a Musculoskeletal (MSK) Assessment Treatment and Triage Service (MATT) in July 2016. At the time MSK services were provided under different contracts with various providers (Oxford University Hospitals NHS Foundation Trust - OUHFT and Oxford Health NHS Foundation Trust -OHFT). These contracts were commissioned at different times and were not designed to work together within an integrated model of care. Several attempts had been made over the previous six years to improve provision of these services; but the focus of review and change had tended to be on discreet areas of service rather than the whole system.

OCCG’s aim was to commission a service where people with musculoskeletal conditions could access high quality, effective and timely advice, assessment, diagnosis, treatment and triage at the right place first time.

Following the procurement process, the contract for MSK services was awarded to Healthshare Ltd. Patient and clinical representatives made up part of the evaluation panel to review the applications.

Healthshare Ltd is a clinical stakeholder organisation which works within the NHS and is solely funded through NHS contracts; it does not carry out any private physiotherapy work and its services are free to patients in the same way as other NHS services.

Most of the staff who have been providing the service through OUHFT and OHFT will continue to do so; they will transfer via TUPE arrangements to be employed by Healthshare Ltd, so current patients will have continuity of care with familiar faces.

Version 1.0

Author: OCCG and Healthshare Ltd

Date: 11th October 2017