Supporting service redesign in South Devon
Liz Thomas In South Devon Local Health Community (LHC), around a third of the population over 50 suffers from chronic knee pain.
As part of their Right Treatment and Choice (RightTRac) programme, the LHC designed a common and consistent knee pain pathway and created a specialist primary care based clinic to reduce waiting times and meet national targets for referral to treatment.
The Role of the Map of Medicine
South Devon LHC adopted the Map of Medicine as a service redesign tool to support the development of a knee pain pathway. Because the Map provides evidence-based, practice-informed clinical knowledge, displayed in an-easy-to-use pathway format, it was the right tool to communicate information about local service redesign and treatment policies.
Milestones
- The development of localised South Devon Knee Pain Pathway was possible by having secondary care consultants working together with GPs and physiotherapists
- The Right TRaC programme team supported the pathway development process and provided awareness and training support for users
- As a consequence of the service redesign, South Devon LHC created a primary care funded knee pain physiotherapy clinic and plans to extend it during 2009/2010.
Challenges
- Commissioning the new clinic across the whole community
- Extending the remit of the clinic to enable the listing of patients for surgery, increasing the positive impact of the service.
Results
Over a six month period, the new Knee Pain Pathway and knee pain clinic are projected to cut 400 consultant appointments in secondary care services, with a saving of at least £60,000, including the cost of the clinic, over 2009/10.
From January to October 2008, referrals to secondary care decreased by 70%, resulting in South Devon meeting Referral to Treatment targets for knee conditions. With more patients being seen in primary care, the waiting time for secondary care has fallen with reduced demand. More patients were appropriately referred, with only 7% of referrals from the knee pain clinic discharged from secondary care at the first outpatient appointment, compared to 29% of patients referred directly from GPs to secondary referrals.