An integrated approach across primary, community and secondary care, East Sussex

Matthew Carr from Sussex MSK Partnership East explains how First Contact Physiotherapy is enabling a joined-up pathway of care for patients.

East Sussex team photo
From left to right: Ali Meades (clinical services manager), Kasia Kaczmarek (service delivery manager) and Matthew Carr (clinical director)

As clinical director of Sussex MSK Partnership East, my role involves coordinating integrated musculoskeletal (MSK) clinical services and ensuring optimal delivery of MSK care for patients in East Sussex.

In the early stages of local FCP planning, I worked with our existing MSK physiotherapy providers to develop a common First Contact Physiotherapy (FCP) model. We focused on ensuring this model aligned to the needs of our primary care network (PCN) and our MSK physiotherapy provider.

I led initial engagement with the nine local PCNs in our region of East Sussex, which involved sharing the values of FCP. This resulted in eight of the PCNs supporting the model and working with us to deliver their FCP services.

Approach

Across East Sussex, we have implemented an integrated approach to FCP. By working collaboratively with colleagues across primary, community and secondary care, we have enabled a joined-up MSK pathway of care for our patients.

Set-up and implementation

To get primary care on board, we initially emailed the clinical director of each PCN and arranged meetings with their clinical and administrative leads to explain the FCP service offering.

We then brought together service leads from the MSK physiotherapy providers and the PCNs to develop a three-party contracting model (PCN, MSK provider and MSK prime contract commissioner), enabling the PCN to contract a local MSK provider to deliver the FCP service in their surgeries.

We have used the Additional Roles Reimbursement Scheme (ARRS) to implement FCP services. The shortfall for costs outside this is funded by Sussex MSK Partnership East as the regional MSK prime contract commissioner, which is responsible for the total MSK system budget. As such, it is able to support funding within primary care MSK services – the cost of which is offset against predicted savings in community and secondary care.

In return, Sussex MSK Partnership East requires monthly performance reports from each FCP service and has a lead role within the FCP’s quarterly clinical governance forum.

GP and Clinical Commissioning Group (CCG) leads are also invited to this (quarterly forum) to gain an overview and to understand quality assurance of the services.

Once this approach was agreed, we set up project groups for each PCN. Everyone involved made a significant time commitment to ensure that each FCP service was developed in a way that complemented and aligned with existing services. 

I have attended the fortnightly meetings for each of these eight groups, along with a designated practice manager and clinical director from each PCN, and operational and clinical representatives from the relevant MSK physiotherapy provider.

These meetings ran for two to three months prior to the mobilisation of each PCN's service, during which we developed a standard project plan. We found that having these initial meetings face-to-face (with social distancing) was helpful to establish good rapport ahead of subsequent virtual meetings, which continued to work well.

Benefits

For patients

  • This approach enhances patient experience as they can receive care closer to their home, treatment is quicker to access and there is consistency throughout the MSK pathway.
  • Patients receive initial care from a specialist MSK physiotherapist (the FCP) who provides the consultation and management. If necessary, the FCP can refer the patient for further treatment or investigation. Because the FCPs are employed by existing MSK physiotherapy providers, they have good knowledge of the whole pathway and can refer patients to the most suitable service in the area.

For the PCN and FCP

  • Our collaborative approach to FCP performance and quality review ensures that our FCPs feel well supported.
  • There is a reduced the risk of isolation for FCPs because we bring them together regularly in our forums – together we share challenges and ideas for how to overcome them, also enabling FCPs to learn from peers in the region.
  • This approach has enabled us to govern and develop our FCP services consistently across East Sussex, ensuring the performance and development of each service is collaboratively reviewed and best practice can be shared.
  • The approach to funding has the additional benefit of ensuring consistency, as Sussex MSK Partnership East is able to monitor the quality of the FCP services and the impact they have on the whole MSK pathway.

Outcomes

We have successfully established regional FCP services within seven of our PCNs in East Sussex. We are in the project planning stage with our eighth PCN and hope to launch this in the coming months.

The eight PCNs have a combined list of 341,875 patients and comprise 34 GP practices. We are commencing these services with 11 physiotherapists and will be working with our PCNs to expand this with a phased and collaboratively planned approach.

Next steps

We are still developing our clinical governance reporting processes. We held our initial clinical governance forum in April at which we were able to review standardised quality and performance measures from each FCP service. This data is helping us build a picture about variation in key areas of practice such as referrals and requests for investigations. These forums will continue to be refined and enhanced over coming months. 

Service reviews will continue on a quarterly basis with each PCN, the FCP provider organisation and Sussex MSK Partnership East to ensure ongoing development that works for the wider regional MSK system.

Key learning points

  • Collaboration with all parties is crucialto ensure that the FCP model developed meets the needs of the PCN as well as the physiotherapy providers.
  • Building good personal relationships from the outset has been vital to successful integration, and resulted in our FCPs feeling part of their respective primary care teams.
  • Carving out time to lead training with the clinical and administrative teams and undertaking peer supervision with GP MSK champions has been really positive.
  • Developing a funding approach to ensure that PCNs are not accountable for any provider costs above the maximal reimbursable limits is key to gaining their support.
  • Dedicating plenty of time to the planning is important, particularly in the early stages – attending fortnightly project groups with several PCNs, with actions to complete in between, can be very time-consuming and demanding.
  • Appreciate that PCNs are still developing their leadership capabilities and that they have different levels of knowledge and understanding relating to MSK FCP roles. Tailor your communication to suit these differing levels and be prepared to fill in the gaps of MSK knowledge and system awareness.
  • Have an independent chair for the project groups (independent from the PCN and the FCP provider) who can be impartial when overseeing and instructing accountability.
  • Develop a local service-level agreement (SLA) co-designed with input from each PCN and the FCP service provider. This helps when you don’t have an existing standard FCP contract between PCNs and FCP providers, and ensures that a consistent model is developed across each service.

More information about this case study

If you would like more details about this case study, please contact Matthew Carr, clinical director of Sussex MSK Partnership East.

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