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NHS LANARKSHIRE STANDARD OPERATING PROCEDURE

MSK AHP REFERRAL HUB (ADMIN)

SOP No.: NHSL-MSK-01 Version No.: 1

Effective Date: 1st June 2012 Copy No.: Electronic

THIS IS A CONTROLLED DOCUMENT AND MUST NOT BE COPIED OR DISTRIBUTED WITHOUT AUTHORISATION BY PETER McCROSSAN

File Name: NHSL-MSK-01(MSK AHP Referral Hub - Admin) version 1

Status: DRAFT of 17


This SOP supersedes all previous versions.

Review Interval: Quarterly until further notice

Prepared by:

Name

Ruth Currie Senga Cree

Job Title

Acting Physiotherapy MSK Manager

Head and Professional Lead of Physiotherapy

Authorised and Reviewed by:

Name

Peter McCrossan

Job Title

Associate Director for Allied Health Professions

This document and all associated appendices and forms have been prepared and authorised electronically. All signatories and dates are traceable through Information Governance.

THIS SOP MUST BE READ AND UNDERSTOOD BY STAFF USING IT AND DOCUMENTED EVIDENCE PROVIDED THEREOF







Status: DRAFT of 17

DOCUMENT HISTORY & CHANGES

• Changes necessitate reissue of the SOP incrementing the version number.

• Changes since the last version was issued are added to the changes log below. Previous changes are incorporated into the re-issued version. The changes log below details all changes made to the SOP.

• Changes to page 1 or headers and footers are not included in the changes log.

• Additions to the changes log are not shown as changes.

Changes Applied to Version

Section Date Brief Description of Change







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This SOP has been read and understood by the following staff members:

Name Position Signature Date







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CONTENTS PAGE 1.0 PURPOSE 5

2.0 SCOPE 5

3.0 REFERENCES 6

4.0 INTERFACE DEPARTMENTS 6

5.0 DEFINITIONS 6

6.0 DOCUMENTATION 6

7.0 GENERAL REQUIREMENTS 6

8.0 PROCEDURE 7

9.0 APPENDIX 14







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1. PURPOSE

1.1 The Scottish Government Health Directorate has undertaken a major redesign of

patient musculoskeletal (MSK) pathways aiming to improve timely access to the most appropriate information and clinical specialist, and support greater cost effectiveness across the system. The development of a centralised referral management system is integral to this work.

The overarching purpose of the MSK re-design is to ensure that patients self-referring into the MSK pathway are triaged into the most appropriate services. These may include self-management, vocational rehabilitation services, leisure services, chronic pain services, general musculoskeletal services, other primary care services and secondary care services. People who are of working age should also be supported to return to work or referred into employability services, as appropriate, early in their rehabilitation journey. Older patients should be signposted into appropriate older peoples pathways (falls pathway) and leisure services.

1.2 The purpose of the referral is to complete organised steps to ensure that patients receive the correct treatment, at the right time, from the right source and no-one is exposed to unnecessary risk from delayed or inappropriate treatment. Furthermore, correct referral prevents overburdening of services which are operating at or close to capacity with inappropriate demand. It is essential to minimise the risks in order to prevent foreseeable occurrences that may result in a reduced quality of life or delay or inability to return to work.

1.3 This SOP describes how to process an AHP MSK Referral, in this instance for

Physiotherapy and how to manage any associated risk.

2. SCOPE

2.1 All NHS Lanarkshire patients suffering with MSK problems who do not demonstrate

RED FLAGS– N.B. RED FLAGS should be screened out by NHS 24 (NATS)

2.2 Referral via NHS 24(NATS) is for age 16+

2.3 Electronic GP referrals are for adults and children with MSK conditions

2.4 Patients must be able to attend an MSK Out Patient Physiotherapy (or other AHP) department

2.5 A separate pathway exist for children (with neurological/congenital issues)

2.6 SOP NHSL-MSK-O1 focuses on the Admin tasks performed in the MSK Hub







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3. REFERENCES

3.1 AHP MSK Service Managers

4. INTERFACE DEPARTMENTS

4.1 All practices must be carried out in accordance with the current ‘NHSL MSK

Policies and Procedures’. If in any doubt about the aspects of MSK triage, seek advice from the Physiotherapy MSK Service or other bodies listed in sections 8.1 and 8.4

5. DEFINITIONS

5.1 WHSS – Working Health Services Scotland. The role of WHSS is to help support people to stay in or return to work more quickly when they develop a health condition or impairment. WHSS will provide personalised and timely back-to-work support for people off sick or moving toward absence from work due to a health condition, the service will enable them to make an earlier return to work than they otherwise would or remain at work, avoiding absence. Support comprises health, employability and wider social support service elements. The telephone based case management approach will through assessment, identify health issues and will ensure that clients are helped to access the most appropriate forms of support in a timely fashion.

6. DOCUMENTATION

6.1 Physiotherapy Hub Handbook

7. GENERAL REQUIREMENTS

7.1 TrakCare login 7.2 Authorisation to access MSK AHP Hub email account 7.3 Authorisation to access ‘Urgent’ spread sheet 7.4 Authorisation to access WHSS spread sheet (FirstPort site when up and running)







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8. PROCEDURE

Figure 1: MSK AHP Referral Hub (Admin) Process Map

Figure 1 shows a high level map of the Admin processes involved in receiving referrals into the MSK AHP Referral Hub and onward referral to Service Providers. N.B. Currently the MSK AHP Hub for NHS Lanarkshire manages only Physiotherapy referrals. This document will be updated as the service evolves to incorporate other AHP professions.

Electronic

Referrals arrive at

Hub via Sci

Gateway

Vetting

Outcome

Call Patient/

letter

Send out appointment

letter

Referral logged

by Hub admin

(via FirstPort

spread sheet)

Referral emailed to

WHSS:

srtwsadmin@lanarkshire.

scot.nhs.uk

Appoint

to case

manager

Discharge

Book capacity up to

4 weeks ahead and

pick up late

additions

Appoint to local

department waiting

list

Discharge

Appointment

required

Appoint to

local

department

waiting list

If no longer require

appointment remove

from waiting list

Urgent

WHSS

Within remit

of AHP Hub

Outside

remit of

AHP Hub

Key:

RMS match

CHI number

Referral posted onto

Lanarkshire AHP

Referral Centre

(TrakCare) vetting list

NHS 24

(NATS)GP

Specialty

ReferralOther

Paper Referrals

arrive via Post

Request photocopied by

AHP Departments and

sent to RMS

Routine

‘Second’ vetting

required for

inappropriate referral

‘On-Hold’Referred on to

appropriate service

by MSK

Physiotherapy

Manager

Temporary

Step:

‘On-Hold’

requests only

occur when

referrals sent to

AHP Hub in

error

OR

Assessment at local

department

Treatment at

local

department

Temporary

Process







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8.1 Methods of Referral to AHP services

8.1.1 Electronic Referral (E-referral) through SCI Gateway onto TrakCare will include GP contact details and unique patient identifier and can be received from:

• NHS24 (NATS) • GP Electronic Referral (see Appendix 9.1)

8.1.2 Written Referral

• Specialty referral (e.g. Orthopaedics, Neurology)

• Others (TrakCare Definitions): o Accident& Emergency o Community Health Service o Consultant at this Health Board o General Practitioner o Other (including Armed Forces) o Prison/Penal Establishments o Self-Refer

8.1.3 Referrals management will be conducted through a referral management Hub as

indicated in the MSK AHP Referral Hub (Admin) Process Map 8.2 Sources of Referral

• As stated in sections 8.1.1 and 8.1.2 8.3 Initial Referral Processing 8.3.1 Electronic Referral via SCI Gateway:

Referrals processed electronically by the Referral Management Service (RMS) onto Lanarkshire AHP Referral Centre waiting list with priority of “Not Vetted”.

8.3.2 Written Referral:

8.3.3 Physiotherapy Process:

Paper referrals will require to be photocopied by Physiotherapy Departments and sent to RMS. RMS process referrals daily, scanning the referrals and adding to Lanarkshire AHP Referral Centre waiting list with a priority of ‘Not Vetted’ as illustrated in Figure 2 below:

********** Text contained within shaded box denotes PHYSIOTHERAPY only processes

**********







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Figure 2: Representation of TrakCare AHP Referral Centre Waiting List

8.4 Referral Process by Category

All referrals will be e-vetted by a specialist clinician. Referrals are accessed

remotely via a computer with TrakCare log on capability. They are vetted daily Monday to Friday and prioritised using prioritisation criteria detailed below:

8.4.1 WHSS

CRITERIA questions asked by referrer to ascertain suitability for WHSS:

• Are you self-employed or working for a small/medium sized company? (fewer than 250 people)

If answer is YES on referral from NHS24 (NATS) or GP follow WHSS process detailed below: N.B. The information gleaned from these questions is taken as accurate by AHP Hub

• Referrals vetted to “WHSS Outcome” will be logged on to the WHSS Referrals spread sheet by Physiotherapist (or AHP) – see Appendix 9.2 for AHP Hub FirstPort Spread Sheet

• Referral (spread sheet) will be forwarded to [email protected]

• WHSS admin staff will accept the referral (or refer back if inappropriate – via telephone call or email*)

8.4.2 Physiotherapy Urgent by Location

CRITERIA**conditions ascertained by referrer to establish need for urgent appointment:

Q1 - patient has severe unremitting pain Q2 - patient is off work at present as a result of the present condition Q3 - patient’s sleep is disturbed by the condition

N.B. The information gleaned from these questions is taken as accurate by AHP Hub







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Patients who meet these criteria should be offered an urgent appointment following the process detailed below:

• Referrals vetted to outcome of “Physiotherapy MSK Urgent” will now be available on the urgent waiting list for booking.

• Urgent referrals will be contacted by telephone and offered an appointment within 5 working days of referral receipt

• Appointments will be offered by location in relation to patient postcode

• If location not available another location will be offered

• If no contact can be made by telephone an appointment letter will be sent by post

• Patients will be advised of NHSL DNA policy by telephone (and information will be included within TrakCare generated appointment letters once sufficient characters available)

• Any urgent slots not required for urgent appointments will be filled with routine NP’s as part of the late addition process

• If urgent slot capacity is not available admin staff will escalate to the Physiotherapist Hub Co-ordinator. The Urgent Waiting List is monitored weekly and is under review at present. TrakCare templates are being amended to incorporate more urgent appointments?

8.4.3 Physiotherapy Routine by Location

CRITERIA conditions ascertained by referrer to establish need for routine appointment:

• All those who do not meet the URGENT criteria set out above in 8.4.2 and are not appropriate for referral to WHSS

Patients who meet these criteria should be offered a routine appointment following the process detailed below: N.B. The information gleaned from these questions is taken as accurate by Physio Hub

• Referrals vetted to outcome of “Physiotherapy MSK Routine” will now be

available on the TrakCare Routine waiting list for booking.

• Routine capacity will be booked by referral Hub admin staff up to 4 weeks ahead at all times.

• Patients will be booked to a location nearest to their home postcode unless requested otherwise (a list of postcodes by department will be available for admin staff)

• An appointment letter will be sent out to all patients. Patients will be advised of NHSL DNA policy (as seen in Appendix 9.3) within the letter

• A late addition process will be in place to ensure utilisation of any cancelled slots(as detailed in the Hub Handbook)







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8.4.4 Physiotherapy MSK Removal Other Reason

CRITERIA conditions ascertained by vetting Physiotherapist to decide not to add a patient to the Lanarkshire AHP Centre waiting list or establish the need for removal from the list

• Referral is for equipment request, domiciliary patient or inappropriate for MSK OP Physiotherapy

8.5 Patient Cancellation

8.5.1 Procedure for administration removals if patient cancels and advises they do not

require New Patient appointment:

• Any New Patient who contacts the Hub to advise they no longer require treatment will be discharged by the Hub staff and removed from the waiting list

• The reason given for the appointment no longer being necessary is recorded against a drop-down list of options generated by TrakCare including:

o Transferred to other Health Board o Attended/Admitted at Private Sector location o Treatment no longer required o Inappropriate addition to list

• No notification is currently given to the referrer that the patient has been removed from the waiting list

8.5.2 Procedure for administration removals if patient cancels and advises they do not require a Return appointment:

• The Hub will change the status on any Return Patients who contact the Hub to advise they no longer require an appointment:

o Arrived o Booked o Cancelled o Not Attending o On Hold

• Their clinician (treating Physiotherapist or AHP) will be advised via email and they will complete the relevant outcome in TrakCare

8.5.3 Service discharge of DNA’s is carried out by AHP Practitioner in accordance with

SOP NHSL-MSK-xx (MSK DNA Physiotherapy)*







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8.6 Out-Patient Waiting List Removals

8.6.1 Return patients who wish to reschedule an appointment: • All return patients who reschedule should telephone the Hub.

• The Hub administration staff will offer the patient the next available appointment with the same clinician.

• The Hub administration staff will add a free text comment to the patient’s profile for the cancelled appointment.

• Where the patient has a question about their rehab programme, the patient will be given the telephone number of the department where treatment commenced and advised to contact their clinician. The clinician should then re-appoint using TrakCare as appropriate.

8.6.2 New patients who wish to reschedule an appointment

• New Patients who wish to cancel or reschedule their first appointment should contact the Hub.

• The Hub will offer the patient the next available New Patient appointment at their chosen clinic.

• If these are not suitable, the patient may be offered a New Patient appointment at another MSK clinic.

• A free text comment should be added by the Hub staff to the patient’s profile 8.7 Clinic Management – Individual Slots

• All clinics will be booked up to 4 weeks in advance

8.9 Clinic Cancellations

• Senior staff in each department will inform Hub administration staff if any clinics are to be cancelled (sick leave etc.)

• Method of notification will be by telephoning Hub

• Hub staff will contact patients by telephone and offer new appointment time

• Clinical staff will telephone any paper diary patients(i.e. those who commenced treatment prior to TrakCare and who have not yet been discharged) to cancel appointments or re-arrange within department

• Clinic cancellations will be recorded for monitoring and reporting purposes







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8.10 Out-Patient List Monitoring

• Waiting times will be monitored on a weekly basis by the MSK AHP Hub co-ordinator

• Performance reports will be available monthly as per data reporting arrangements. Data is extracted from TrakCare onto the Milan system every month and given to the Heads of AHP Services , AHP Director and National Programme Lead

8.11 Reports and Updates

• Monthly activity figures are extracted from TrakCare onto MiLan, collated and submitted to the Head of Physiotherapy, AHP Director and, National Programme Lead.

• For further information on the reports and updates for WHSS please refer to the NHSL-MSK-02 (National Communication) SOP

*currently under development

**subject to change following review April 2012







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9. APPENDIX

9.1 GP Physiotherapy e-Referral Form

Physiotherapy MSK Referral

Presenting Complaint

MSK Specific Questions







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9.2 AHP Hub FirstPort Spread Sheet

Date Received

by WHSSWHSS Outcome

First Contact

Date by WHSSHUB Outcome(only required if WHSS Return to NHS HUB)

Date Comments Open/Closed

04-Mar-12 Return to NHS HUB

(please select from drop

down) (enter date) Open

05-Mar-12 Return to NHS HUB

Return Referral Accepted

by HUB ###### Closed

06-Mar-12 Accepted by WHSS Closed

07-Mar-12

Transfer to other SALUS

CM Project Closed

DATE

ELECTRONIC

REFERRAL

RECEIVED

- HUB -

DATE

REFERRAL

VETTED

- HUB -

PATIENT

SURNAME

PATIENT

FORENAME

PATIENT

DATE OF BIRTH

PATIENT

ADDRESS

PATIENT

POSTCODE

PATIENT

TELE #

PATIENT

CHI

PATIENT

GP NAME

PATIENT

GP ADDRESS

PATIENT

GP TELE #

PATIENT

SOURCE

OF

REFERRAL03-Mar-12 03-Mar-12 Einstein Albert 25-Aug-72 26 Where Street KA10 1AB 7797111111 AAAAAAA Mr Help 101 Edinburgh Street 7971111111 NHS24

03-Mar-12 03-Mar-12 Darwin Charles 26-Aug-72 27 Where Street KA10 2CD 7797111112 AAAAAAA Mr Help 102 Glasgow Street 7971111112 GP

03-Mar-12 03-Mar-12 Watson James 27-Aug-72 28 Where Street KA10 3EF 7797111113 AAAAAAA Mr Help 103 Dundee Street 7971111113 Ortho

03-Mar-12 03-Mar-12 Curie Marie 28-Aug-72 29 Where Street KA10 4GH 7797111114 AAAAAAA Mr Help 104 Aberdeen Street 7971111114 Other

03-Mar-12 03-Mar-12 Faraday Michael 29-Aug-72 30 Where Street KA10 5IJ 7797111115 AAAAAAA Mr Help 105 Stirling Street 7971111115 NHS24

03-Mar-12 NHS24

NHS24

Lanarkshire MSK

WHSS Referrals







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9.3 NHS Lanarkshire AHP Physiotherapy DNA Policy Poster

AHP PHYSIOTHERAPY

DID NOT ATTEND (DNA) POLICY

New patients will be discharged (in line with New Ways Guidance)

• after one DNA where the department has not been contacted prior to the patients appointment

• after 3 consecutive Could Not Attend (CNAs)

• after 3 CNAs within an agreed episode Return patients will be discharged

• after one DNA where the department has not been contacted prior to the patients appointment

• after 2 consecutive CNAs

• after 3 CNAs within an agreed episode

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