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Summary 01
Chapter 1: M usculoskeletal Services Framework 04
Chapter 2: Where we are now 10
Chapter 3: Care outside hospital 18
Chapter 4: Care at the interface 26
Chapter 5: Hospital care 34
Chapter 6: M aking the changes 50
Annex: Roles of health and social care staff 52
Summary 02
M usculoskeletal Services Framework
Where we are now
Care outside hospital
Hospital care
The purpose of this document – The Musculoskeletal Services Framework. A joint responsibility: doing it differently – is to support the improvement of services for people of all ages with musculoskeletal conditions, whether these are the result of disease, injury or developmental disorder, to ensure that everyone receives a high-quality service.
Chapter 1 06
Shared care
Chapter 1 08
Step 1: Information and education
Step 2: Access to high-quality front-line care
Step 3: Ensuring appropriate access to a range of specialist opinion
Step 4: First-line specialist opinion in musculoskeletal CATS
Step 5: Pre-listing clinical assessment
Step 6: Listing for surgery
This would only occur using a local protocol agreed by consultant orthopaedic surgeons, which also builds in time for the orthopaedic surgical team to assess the patient before operating, and to obtain legally required informed consent to treatment
Step 7: Pre-surgical assessment
In pa tie nt an d o utp at ie nt f ollo w-u p D ir ect li st in g of r ou ti ne cas es u nd er lo cal ly ag reed p ro to co l an d co ns en t 1 2 3 4 6 7 5 8 1 Mu sc ul os ke le ta l in te rf ac e clin ic s 2 Pr e-lis tin g assessm en t Pr e-su rg er y assessm en t cl in ic C ons ul ta nt team r ev ie w H ip a n d kne e pa in p at ie n t f lo w f rom pa in on se t to s u rge ry
Chapter 2 12
Scope of the disease and key facts
children
Chapter 2 14
The national priority areas
Milestones to 2008
Chapter 2 16
The poor experience of a patient with back pain – 2005
Outpatient
5 stages: 373 days Diagnostics Inpatient
good pain control speedy and clear access to services
Case management
Disease management
Chapter 3 20
Health and social care services will want to make sure that as many people as possible benefit from such support.
Understanding and managing risk factors in making available or developing information
Chapter 3 22
strongly recommended
Ensuring that the public can access advice
Case study
Chapter 3 24
children and their families
To set up a CATS
Task 2
Task 4
Chapter 4 30
Symptom control and pain management support
Interface service •
• • The Somerset model for back pain management
Chapter 4 32
Introduction to rheumatological conditions and their treatment
rheumatological conditions
Chapter 5 36
The costs to society and the individual
Hospital outpatient rheumatology services
reviewed regularly
osteoporosis services
day-case
Case study
Chapter 5 38
Chapter 5 40
B. Highest numbers of elective FCEs by OPCS4 codes (2003/ 04)
D. Trends in primary and revision knee replacement rate, 1991–2000, and projections to 2010, by sex
E. Variation in intervention rates by primary care trust, for a range of procedures
F. Socio-economic inequalities of access, primary hip replacement rates, 2000, by social class (England)
Chapter 5 42
Inequalities in access to musculoskeletal services
Chapter 5 44
Trauma
Chapter 5 46
Waiting times in T&O
Improving elective care
Chapter 5 48
Improving discharge and follow-up
discharge
follow-up
wide engagement basic delivery cycle
care pathways
prevention and self-care through to hospital care
Clinical Assessment and Treatment Service (CATS)
information management
Annex 54
Advanced Practitioners:
Consultant AHP:
Ambulance service staff
Annex 56
Clinical psychologists
Annex 58
Pharmacists
community pharmacy contractual framework
consultant pharmacist
local pharmaceutical services
supplementary prescribing
Specalist consultants
Pain medicine specialists
Radiologists
Rehabilitationists
