Is a primary care orthopaedic interface service sustainable in a continually changing political and healthcare environment?

Ferguson, Sarah L.; Cook, Fiona

doi:10.1108/14777271111124491

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…It is difficult to study for many reasons. The first main difference is that in many cases there are set tariffs per appointment in the NHS for medical intervention but not allied health intervention which are usually on block contracts (Ferguson and Cook, 2010). In Australia, in some circumstances there is a tariff for allied health intervention but it does not take into account the advanced role and possible investigation costs (Blackburn et al, 2009).…”

Section: Orthopaedic Triagementioning

confidence: 99%

Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates

Burn

Beeson

2014

Clinical Governance: An International Journal

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Purpose – The purpose of this paper is to investigate cost effectiveness, diagnostic rates, surgical percentage and appropriateness for orthopaedic referrals and number of patients able to be seen in orthopaedic triage from GP orthopaedic referrals. Design/methodology/approach – The study involved triaging paper referrals for orthopaedic outpatients to an interface service, orthotics or continue normal route. Data were collected on outcome of the interface appointment and outcomes for those patients referred to orthopaedics from the appointment. Findings – The study demonstrated a 27.3 per cent cost saving from the normal orthopaedic route with 86.1 per cent of patients able to be managed by an extended scope physiotherapist (ESP) without requiring orthopaedic assessment. Appropriateness of onward orthopaedic referrals was 80.5 per cent with surgery conversion rate of 75 per cent. Originality/value – Although triage and ESP positions have been studied before, this is the first known study to look at cost effectiveness across the patient pathway despite this being a large reason for the creation of these positions. Further larger studies are required to build upon this base in terms of demonstrating the cost effectiveness of the value of these positions.

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Section: Orthopaedic Triagementioning

confidence: 99%

Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates

Burn

Beeson

2014

Clinical Governance: An International Journal

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“…For example, the Bath and North East Somerset Orthopaedic Interface Service retained 50% of referrals passed to their system, sending only 21% on to see an orthopaedic surgeon. 196 However, other RMCs have been established to screen all referrals, with an explicit or implicit aim of reducing hospital outpatient attendance. The aim of these services is to identify inappropriate referrals, which can be considered in terms of three broad categories:…”

mentioning

confidence: 99%

“…In our current review, we identified six studies [193][194][195][196][197][198] about RMCs (Table 16). …”

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confidence: 99%

Outpatient services and primary care: scoping review, substudies and international comparisons

Winpenny

Miani

Pitchforth

et al. 2016

Health Serv Deliv Res

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AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.

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“…The issue of fiscal responsibility raised important questions, including who takes ownership for mismanagement of fiscal resources allocated to health care (Vernon ), how resources can be used to make the provision of services better while simultaneously supporting the longevity of services to the public (Dhalla ). It is by way of such discussions that underlying power relations emerge as they relate to the multitude of stakeholders invested in sustainability efforts (Ferguson & Cook , Taylor‐Gooby ). The relationship between sustainability efforts and power was highlighted by Khanal (), who described the role of sustainability in mobilizing communities through participatory action with the collaboration of Non‐Governmental Organizations.…”

Section: Resultsmentioning

confidence: 99%

Sustainability: an evolutionary concept analysis. Exploring Nursing's role within the sustainability movement

McMillan

2013

Journal of Advanced Nursing

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Is a primary care orthopaedic interface service sustainable in a continually changing political and healthcare environment?

Cited by 8 publications

References 16 publications

Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates

Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates

Outpatient services and primary care: scoping review, substudies and international comparisons

Sustainability: an evolutionary concept analysis. Exploring Nursing's role within the sustainability movement

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