Recommendation – access• NHS 24’s functions as a

resource for rehabilitation advice and triage should be explored.

www.rehabilitationframework.scot.nhs.uk

Sarah.mitchell@scotland.gsi.gov.uk

Delivery Framework ForAdult Rehabilitation

Key role for NHS 24

• Providing information to support self management

• Delivering effective and evidence based triage• More efficient and effective service delivery to

enhance the patient pathway and outcomes for patients

• Innovative service delivery through tele- rehabilitation

• Delivery of national targets (18 weeks)

Exemplar Musculosketal re-design• Existing systems for self

referral to physiotherapy need to be streamlined and utilised in a more cost effective manner.

• Nhs 24 could provide single point of access into physiotherapy services .

Exemplar Musculosketal re-design

• Part of a whole systems MSK pathway

• Onward referral management systems

• Self management advice

• Websites as support for self management

CommunityAHPMSK

Services

Integrated MSKTeam

PhysiotherapyPodiatry

OTDietician

ProstheticsRadiography

Specialist nurseGPwsi

Self Referral via NHS 24

Self management and advice through NHS 24 web base for rehabilitation

GP Referral

Walk in Self Referral

Electronic Referral

Vocational Rehabilitation

Services & Chronic Pain Services

Orthopaedicwaiting list

Rheumatologyservices

Other acute services

Electronic Referral

GP Referral Electronic Referral

NHS 24 – Enhancing the MSK pathway

Rationale for self referral

• Self referral into physiotherapy services provides cost efficiencies of up to £2 million compared to GP referral. Figures based on 2004 figures prior to Consultant and GP contracts. (Holdsworth 2007)

• In the UK 12.25 million work days are lost due to musculoskeletal disorders.

• Low back pain is the most common musculoskeletal problem affecting an estimated 18 million people, with associated costs of £5bn p.a. to the economy due to working days lost.

• In Scotland physiotherapists’ treat over 64,000 back pain patients and a total of 271,000 MSK patients per annum.

Benefits of this change in service delivery

• Improve access to diagnosis and treatment• Reduce waiting times• Improve conversion rates to surgery in secondary care• Provide greater efficiency and productivity• Support shifting the balance of care and other Government

policies (rehab framework, patient experience etc)• Develop and enable a self management culture for patients in

Scotland• Promote health and well being• Facilitate early return to work and avoid long term absence

and long term dependency on benefits

Future developmentsIn the pipeline Dietetic services – planned demonstrator programme with

NHS Lothian and Highland. Rehabilitation web based advice – working backs etc Potential for innovation falls, mental health Tele-rehabilitation Link MSK work to national fit for work pilots for vocational

rehabilitationNext steps AHP Leadership within NHS 24