Quality Account 2014-15 Community MSK (NHS) Services

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Contents

Introduction 3 Part 1 1.1 Chief Executives Statement 4 1.2 Medical Directors Statement 6 1.3 Statement of Assurance 7 1.4 Further Information & Feedback 7 1.5 Quality Assurance & Quality Management 8 1.6 Regulatory Compliance 8

- CQC Inspection & Compliance 8 - HSCIC Compliance (IGSoC) 9

1.7 Contribution to National Audit Databases 9 1.8 Clinical Governance at Connect 10 Part 2 - Key Successes & Achievements 12 2.1 Innovating the MSK Pathway (Newcastle West Pilot) 12

- Improved appointment waiting times 12 - Improved GP/Onward Referrals 12 - Improved patient Experience 13 - Improved GP Support 13 - Reduced patient waiting times & direct access to surgery 14 - Direct Access to Surgery 14 - Improved Clinical Outcomes 14 - Effective Partnership Working & Commissioner Experiences 14

2.2 Award winning Services 15 2.3 New MSK Commissioning Model 16 2.4 Community MSK Service Development 16 2.5 Results of Clinical Audits 17

- Patent Safety Audits 17 - Evidence of Clinical Effectiveness 20 - Measuring patient Experience 23

Part 3 - Key Developments & Improve net Priorities (2015/16) 26 3.1 Improved Complaints & Concerns Reporting and management 26 3.2 Further Accreditation & Registration (Quality Standards) 27 3.3 Clinical Outcome (PROM) Development 27 3.4 Our ‘Fit for Future’ Programme 38 3.5 Appendix 1- Glossary of terms 30

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QUALITY ACCOUNT 2014 – 2015

Introduction Connect is the largest independent specialist community provider of Musculoskeletal (MSK) & physiotherapy services to the NHS. Last year alone, Connect received over 150,000 MSK referrals. 12 Clinical Commissioning Groups across the UK trust Connect to provide high quality, safe, cost-effective and innovative approaches to care for their NHS patients. Our consultant-led, multi-disciplinary teams operate to the highest clinical standards, supported by the latest in technology, so patients have swift access to services and receive seamless care. Using bespoke systems, patient referrals are quickly processed through our Referral Management Centre, where we ensure patients with musculoskeletal conditions are seen by the right people, in the right place, at the right time. This is crucial to improving outcomes and patient experience, where better care in the community is delivered locally and conveniently and ensuring unnecessary hospital appointments are avoided. Our services are evidence-based and include self-management tools for patients, telephone and web-based advice, access to diagnostics, face-to-face assessment & treatment and up to date information resources for patients and GPs.

Current Services Provided Connect is a specialist Musculoskeletal (MSK) care provider delivering:

Community MSK services for the NHS/Local Authorities (local public)

Occupational Physiotherapy services for employers (and their employees) Our NHS community MSK services deliver the following:

Telephone triage (assessment & advice)

Clinical triage & CATS

Practice based physiotherapy

Consultant outpatient services (in the community)including Orthopaedic, Rheumatology and Pain Management

Rehabilitation

Minor surgery including joint injections and US guided interventions

Podiatry

GP advice line

Referral Management Centre providing a single point of contact, all associated administration and patient pathway coordination

Our Occupational Physiotherapy services deliver the following:

Assessment & Treatment Services commissioned by employers for their employees

Onsite and offsite occupational physiotherapy solutions

Pro-active(preventative) management of MSK disorders to support wellbeing and ‘fit for work’ initiatives

Advice & Education (employee & management training)

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Part 1

1.1 Chief Executives Statement A Quality Account is an annual report that providers of healthcare services to NHS patients must publish about the quality of services they provide. This is the first Quality Account published by Connect, relating to the Community Musculoskeletal (MSK) Services we provide to the NHS. As well as showing our commitment to providing the best quality community services, the Quality Account also provides an opportunity to look at what we have achieved and also identify areas where we can make improvements next year. We continue to collect a great deal of information on the quality of all of our services, within the ‘three areas of quality’ defined by the Department of Health:

Safety

Clinical effectiveness

Patient experience We use the information to examine our performance and to determine where further improvements can be made. Areas for improvement and lessons learned from 2014/15 have now been built into our annual objectives and incorporated into our Clinical Governance Framework and our Clinical Strategy for 2015/16. At a time when demand is growing and budgets are shrinking, we continue to maintain exceptional standards of patient care, offering a range of quality, patient-focused services with low waiting times that consistently produce outstanding feedback from patients and GPs alike. Over the last few years, we have found that successful partnerships with NHS Trusts or other Independent Health Care organizations is far more efficient and productive than working in isolation. Through our own established partnerships we’ve proven that, collectively organizations can cost-effectively adopt new models of care and adapt new methodology, to improve patient experience and outcomes Our staff are the backbone of our business and if patient and GP satisfaction is a true measure of how they deliver care, then we should all be pleased with the success and the feedback we have achieved to date. This is underpinned by our Core Values across the business, namely:

Integrity: we act with integrity in all we say and do

Positive: we have a positive attitude to life and work

Supportive: we are supportive to the needs of our patients, colleagues and clients

Passion: we are energetic and enthusiastic and have a genuine desire to make

a difference

Growth: we believe that a commitment to personal growth and development will

lead to success for all

Delivery: we understand the importance of doing what we say we will do and

delivering on time, every time

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We believe our Clinical Governance Objectives and Clinical Strategy reflect the needs of patients, commissioners and the people we work with, all of whom have contributed in different ways to developing and informing our services over the years and recently our 2015/16 objectives. We will ensure this is also the case when it comes to reviewing our services next year and writing our 2015/16 Quality Account.

Andrew Walton

Executive Chairman

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1.2 Medical Directors Statement As Medical Director, my responsibility is to ensure that the clinical services we provide are safe, effective, evidence based, up to date and of a high quality. This has been achieved through the development in 2013 of our Clinical Governance Framework and more recently our Clinical Leadership teams, both of which have provided guidance and support to our clinical teams of Consultants, Doctors, Physiotherapists and other Allied Health Professionals. Working together with patients, commissioners and staff, we have developed our Community MSK model of care and enhanced patient experience. Working with our NHS partners, we have developed more integrated care pathways and created efficiencies whilst ensuring quality and governance are maintained. We will continue to measure our performance against national and local standards of care and ensure that we learn lessons from any negative feedback or mistakes that we make. Our Clinical Strategy for 2015/16 has defined 3 main areas of focus which will further enhance the care that we provide to our patients, namely:

1. Develop Consistency & Excellence in Clinical Care Review & Develop MSK Clinical Guidelines Review & Develop Clinical Audit

2. Develop Clinical Leadership Teams Develop Leadership Structure and training programmes

3. Ensure Excellent Clinical Service & Profile Establish Research & Development links with Higher Education Institutions

Identify areas for innovation Maintain high levels of CQC compliance

We look forward to continuing to delivering the highest standard of care to those patients who currently access our service and also introducing ourselves to the new patients we will meet, all of whom place trust in us to deliver effective solutions for the musculoskeletal problems they are experiencing.

Dr Graeme Wilkes, Consultant (SEM)

Medical Director

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1.3 Statement of Assurance We confirm that this, our first Quality Account, presents a true picture of the quality of services we provide, that the information is reliable and accurate and there are proper controls over the collection and reporting of data.

We confirm that this Quality Account conforms with the Department of Health guidance and is open to scrutiny and review.

1.4 Further Information and Feedback If you would like any of the following:

to give us feedback on any aspect of this Quality Account

a hard copy of this quality account

a copy to read it in a different language

to talk to someone about your experiences of our community MSK services

to find out more about how to access our services

please email customerservices@connectphc.co.uk or phone 01912504580

30th June 2015

Andrew Walton Executive Chairman

30th June 2015

Dr Graeme Wilkes, Consultant (SEM) Medical Director

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1.5 Quality Assurance & Quality Management

Quality Assurance at Connect is a priority. Our service standards are benchmarked against

local and national regulatory & legal requirements, as well as those defined through specific

bodies and organisations such as the Chartered Society of Physiotherapy, the General

Medical Council, the Health Care Professions Council, the Care Quality Commission and the

Health & Social Care Information Centre.

We undertake routine structured audits of our services, as well as external accreditation and

inspections.

Our ‘Whistle Blowing Policy’ and ‘Duty of Condor’ underpins our ‘no blame culture’ where we

impress upon staff the importance of learning from any errors or mistakes and apologising

where we are at fault so that we can improve services for the benefit of future recipients of

our care.

1.6 Regulatory Compliance Care Quality Commission (CQC) Inspections & Compliance

Assuring good quality services delivery is incredibly important to Connect. Evidencing quality assurance, allows us to govern, regulate and improve the service provided by our physiotherapists and doctors across the company. Connect are a Care Quality Commission (CQC) regulated provider for community MSK physiotherapy services. We have a robust approach to internal quality assurance monitoring so that we can benchmark ourselves internally and but also externally where possible. Connect is registered with the (CQC) under the following ‘regulated activities’:

CQC Registration Reference Number

CQC Organisation Identification number 1-151592833.

1. Transport services, triage and medical advice provided remotely

FR25212_2_2

2. Diagnostic and screening procedures

FR25212_2_3

3. Treatment of disease, disorder or injury

FR25212_2_1

Since our registration with the CQC in 2011, Connect has had 2 inspections, once in Feb

2013 and also in Jan 2014, both of which Connect was deemed to have ‘met the required

standards’. As such, no enforcement notices or improvement plans have been issued and

Connect have no ongoing investigations with the Care Quality Commission.

For 2014 report see: http://www.cqc.org.uk/sites/default/files/old_reports/1-

181584100_Connect_Physical_Health_Ltd_INS1-672647664_Scheduled_26-02-2014.pdf

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The categories inspected and overall summary of the inspection can be seen in the table

below:

CQC Standard Inspected

Date of Inspection

Standard met

Care & Welfare of People who use the service

28/02/2013 24/01/2014

Consent to care & treatment

24/01/2014

Management of medicines

24/01/2014

Supporting workers

24/01/2014

Maintaining Records

24/01/2014

Respecting & involving people who use services

28/02/2013

Safeguarding people from abuse

28/02/2013

Managing complaints

28/02/2013

Requirements relating to workers

28/02/2013

HSCIC Compliance (IGSoC)

Connect is registered with the Health & Social Care Information Centre (HSCIC) and

undertakes annual accreditation. Connect has maintained its IGSoC accreditation of ‘Level 2

Business Partner’ status every year since 2011. This provides patients and commissioners

with confidence that all data and records are securely held/transferred by Connect and are

compliant with NHS Standards and the Data Protection Act.

1.7 Contribution to National Audit Databases Within the National Clinical Audit and Patient Outcomes Programme (NCAPOP), there are limited options for involvement in National Audit Database such as with schemes with Healthcare Quality Improvement Partnership (HQIP). However, the applicable National Audit Database contribution does include the National Joint Registry (NJR). Within our Newcastle IMATT contract, through collaborative arrangements we subcontract orthopaedic surgeons to work in a community MSK service. These surgeons determine and select patients for operations such as joint replacements. We have consistently contributed towards NJR for knee, hip, shoulder and elbow arthroplasty in this contract. However, given the nature of our partnerships, the overall contribution is provided by our partners where the arthroplasties (surgery) has taking place ie in the acute hospital setting of Newcastle Upon Tyne Hospitals Foundation Trust.

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Given the types of services (musculoskeletal services) we provide at Connect, there are no other types of audits for long-term conditions that apply to the services we deliver. However, Connect would like to work with HQIP in the future to explore whether there are opportunities to establish MSK non-surgical care national audit areas within the National Audit Database with professional bodies such as the Chartered Society of Physiotherapy (CSP) and other professional networks, within the profession of physiotherapy. Connects National Clinical Manager is registered as a member of NCAPOP and will work with HQIP to explore this in the future.

1.8 Clinical Governance at Connect At Connect, Clinical Governance is the heart of our business and company culture/ways of working. It is used to support our patient-professional partnership, in order to for delivery safe services, excellent clinical outcomes and patient experience. Connect contributes to the National Audit database as well as Commissioning for Quality & Innovation (CQUIN) Data. Connect’s Clinical Governance Framework provides a vehicle for the safe implementation, auditing and improvement of each individual service, incorporating staff and patient input, evidence based practice, and regulatory/legal compliance within requirements of MSK healthcare. The mechanisms and infrastructure for clinical governance in place are clear, well established and well communicated throughout the business, which can be implemented with ease across numerous locations and adopted consistently across a range of service models. This allows us to effectively meet the needs of our clients who include commissioners, patients, GPs and staff. It is essential at Connect for Clinical Governance to reach every level of our healthcare organization to work effectively. This structure starts with the 7 pillars of clinical governance are outland here which Connect have adopted:

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Under each pillar of clinical governance, we have a series of systems, processes policies, procedures that underpin the delivery of this framework. This structure allows for local ownership of Clinical Governance, balanced against the need to analyse, monitor and reporting on the delivery of safe and effective healthcare under delegated responsibility throughout the organisation. Connect’s business audit design process, allows for a great opportunity to:

Benchmark quality standards between services internally

Benchmark against external standards where these are published.

Identify training needs and service improvements to meet agreed standards of care

Participate in future national audit and research- such as through Healthcare Quality Innovations Project (HQIP)

The CG framework ensures a cyclical process of Continuous Improvement of service quality, ensuring standards are maintained, delivery is re-evaluated and healthcare models are refined for the benefit of patients, commissioners and staff. These are reviewed quarterly at our Clinical Governance Group (CGG) Meetings as well at local & regional Clinical Steering Group and Contract Service review meetings. With Connect being a multi-centre MSK provider on a local as well as national level, we have the unique opportunity to internally as well as externally benchmark our services to assure that quality standards are being maintained and the approach in our Clinical Governance Framework, which underpins the delivery of quality & safety, is being met across all our services. We will showcase examples of this here in this Quality Account.

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Part 2 Key Successes & Achievements (delivered to date) Over many, but particularly in recent years, we have achieved a number of key successes which meet the DoH criteria within this Quality Account, namely; ‘Safety’, ‘Clinical Effectiveness’ & ’Patient Experience’.

2.1 Innovating the MSK pathway – Newcastle West Pilot In 2011/12 Connect partnered with Newcastle West Clinical Commissioning Group (NWCCG) and Newcastle upon Tyne Hospitals NHS Foundation Trust to establish an innovative pilot to try and reform local MSK services. The results were exceptional. Details of the pilot and video clips of service users’ experiences (patients & commissioners) can be found in the following link: http://www.connectphysiotherapy.co.uk/connect-the-nhs-2/newcastle-west-pilot/

Working with nine local GP surgeries and a total patient list of over 77,000, NWCCG commissioned Connect to undertake a MSK pilot study for two years (2011 & 2012). Other than defined exclusions, GPs referred all patients to the community service, leaving the decision to access secondary care to the MSK CATs service itself. The new physiotherapy service was sited in numerous GP practices to improve access and reduce wait times for patients. Every referral was sent to Connect’s specialised ‘call & referral management centre’ (RMC). This meant patients were contacted, screened and booked into appointments promptly and efficiently. Telephone triage (known as PhysioLine) was introduced so patients could receive immediate guidance & advice over the phone, from the comfort of their own home. Sports, exercise and orthopaedic specialists were included as part of the clinical team so patients had specialist care in a convenient and accessible location - in the community.

The Results: Improved waiting times for appointment in pilot service (working days)

Physioline (Telephone) 2

Physiotherapy ( face to face) 6

MSK CATS (Diagnostics and/or Injection ) 19

Improved GP & onward referrals for MSK conditions

GP Referrals to:

2010 2012 % Variance

Orthopaedics 760 455 -40%

Rheumatology 252 231 -8%

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Neurosurgery 87 49 -44%

CATS 424 769 +81%

Physiotherapy 860 2356 +174%

Total

2,383

3,860

+62%

Improved patient experience with new service model

Widespread GP Support

97% of GPs rated the reformed MSK service ‘better’ or ‘much better’ than 2010

81%

16%

3%0%0%0%

Overall, how would you rate the care you were given by CATS?

Excellent Very Good Good

40%

33%

18%

8%

Overall, how would you rate the PhysioLine Service?

Excellent Very Good GoodFair Poor Very Poor

92%

8%

0%

How would you rate the care you were given by the physiotherapist?

Excellent Very Good GoodFair Poor Very Poor

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79% of GPs rated the service as an improvement for patients

Reducing waiting times & costs to the NHS whilst improving delivery

The pilot delivered 62% more patient care in 2012 than 2010, whilst reducing overall

expenditure and waiting times. In just six months, the pilot saved the NHS £42,000 (£80k

pa) for only a relatively small population of patients.

Direct access to surgery

Appropriate referrals, assessment and investigations as well as direct access to surgical

consultants in the community meant that appropriate patients only were fast tracked through

hospital surgical lists and received speedier treatment (which also made best use of

consultant’s precious time).

Improved Clinical Outcomes

Validated Patient Reported Outcome Measures (PROMS) were used during the pilot (EQ5D -5L) which demonstrated statistically significant improvements as compared with the previous model of MSK care.

Effective Partnership Working The pilot clearly demonstrated that a partnership that works between a CCG, Foundation NHS Trust and an independent NHS provider can be cohesive, cost-effective and produce outstanding results for the NHS and its patients.

The Commissioners Experience "The pilot service that we have been running has been a great success. Popular with patients and with GP’s, the service has been shown to be responsive, of high quality and cost-effective. The rapid community based physiotherapy response has been highly valued, as has the expanded Intermediate CATS service using extended scope physiotherapists, secondary care consultants and a Sports Exercise Medicine (SEM) consultant. The inclusion of secondary care consultants has helped fully integrate the pathway. The collaborative working of these specialists in community settings has been a major achievement and the SEM consultant has been central in building these arrangements." Dr Guy Pilkington, GP Chair for Newcastle West CCG

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2.2 Award Winning Services - Leadership award

Chartered Society of Physiotherapy (CSP)

http://www.csp.org.uk/frontline/article/gateway-new-approach-vanessa-haycocks-award-

winning-msk-service

When Vanessa Haycock spoke to Frontline about winning a prestigious CSP leadership

award, the head of community physiotherapy in west Newcastle for Connect Physical Health

immediately mentioned the team effort that made her success possible.

‘Even though it’s a leadership award, we’ve taken it very much as a team award,’ is her view of the accolade. It recognises Mrs Haycock’s role heading a 13-strong physiotherapy team during in pilot, which began on 1 January 2011, to establish a community musculoskeletal (MSK) service in the west of Newcastle. Mrs Haycock said she believes that a successful service is built by ‘knowing what your patients want – and not assuming what they want’. But she adds that it was important to keep GP satisfaction high, and says she encouraged the Connect team to build relationships with GPs and commissioners. Connect used the EQ-5D standardized measurement of its services during the pilot, a measurement the Chartered Society of Physiotherapy (CSP) is keen to promote. The change in EQ-5D results for the physiotherapy service provided during the pilot was described as ‘statistically significant’.

The Patients Experience

“The benefits of Connect Physiotherapy are numerous and I couldn’t recommend it enough.

Short waiting times and being able to receive treatment at my local GP surgery really helped

my situation.”

Mrs Julia Watts, West End, Newcastle upon Tyne

“I was at the end of my tether and made an appointment with my GP who recommended

physiotherapy to help ease the symptoms and the pain I was feeling. I called Connect that

day and they were able to assess me over the phone, offer advice and refer me to a

physiotherapist the following week in my local area.”

Mr George Kernan, Sunderland

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2.3 New 2015 MSK Commissioning Model One new contract win of note, is within the NHS in South West Essex, which recently went live in April 2015. It is the first occasion that an NHS Acute Trust provider organisation (as opposed to a commissioning one) has outsourced a community MSK service to the independent sector. The service is already delivering greater integration and improved patient experience as waiting times drop, with consequent reductions in cost. By proving this model, we hope to learn from our experiences though feedback from patients, referrers and commissioners, which will in turn inform further service improvements and open opportunities for Connect to work in an integrated way with other hospital trusts, in order to help them achieve their objectives. The Commissioners Experience: “Connect have taken a refreshing approach to partnership working with the Trust, with an emphasis on building up the relationship and establishing trust between the key parties. We have had an open and honest dialogue and Connect have clearly demonstrated that they have expertise in designing patient-centred services that deliver positive outcomes.” Emma Timpson, Deputy Commercial Director, Basildon and Thurrock University Hospitals NHS Foundation Trust

2.4 Community MSK Service Development (Listening to

Patients, GP’s & Commissioners)

An example of overcoming challenges and developing services is well demonstrated in our

Camden service in London.

The service was established to deliver a community MSK service and has been successfully

delivered through integrated working with 2 large acute trusts including the Royal Free

Hospital and University College Hospital, a community NHS trust, the local authority for

physical activity, three diagnostic providers, the national centre for sports medicine and the

third sector.

The service has developed to meet local population and commissioner needs, has recently

been extended to include MSK pain management and we are currently working with Public

Health and the Institute of Sports and Exercise Health to develop a highly innovative

pathway that is focussed around prevention of chronic disease. This service is held in very

high regard by Camden CCG, GPs and patients as a good and well-integrated service,

where the following improvements have been made:

Multi provider working – ensuring that the collective expertise is valued and used as

effectively as possible so that the right people are involved and engaged early to

deliver a truly effective pathway

Pathway design – building services around the patient to ensure an holistic patient

centred approach is adopted

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Identifying interdependencies and developing integration between services to ensure

seamless communication & high quality patient care

Single point of access, ensuring patients are directed quickly to the right place, right

clinician at the right time for the right treatment/management and with the most

effective use of resources

Improved capacity and demand management to ensure that the new service and

pathway configuration can work

Patient needs – diverse patient are more accounted for with the new service and with

delivery flexible enough to react to each patient as an individual

Identifying and understanding local needs, demographics and key relationships was essential to overcoming challenges. Early contact with each provider and open discussion of the clinical pathway initiated on-going relationships. Communication and early engagement has ensured that all linked organisations, our own team and our patients understood how we should work together for optimum patient care, measured through patient feedback & experience as well as outcomes measures and audit.

2.5 Some Results of Our Clinical Audits

Connect undertakes 12 different types of ‘essential clinical audits’ and these are monitored through robust reporting systems, with local teams owning responsibility to complete these. Over the past 12 months, Connect have invested heavily in clinical audit infrastructure, such as improved reporting systems and appointment of Regional Clinical Leads which in turn has directly supported the delivery, completion and effective use of the data from clinical audit to inform and improve services. Below is a summary the monitoring process and the improvements we’ve made this year on completing the 12 clinical audits per service per year:

Patient Safety Audits:

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q1 Q2 Q3 Q4

Clinical Audits Completed & Reviewed over the year 2014-15

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Further, as a result of our internal benchmarking systems, we can provide visibility of this to

our national Clinical Governance Group against quality standards for our national contracts,

allowing us to internally benchmark our services. An example of this is the Diagnostic

imaging referral quality audits outlined below by national services:

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Camden CATS

Newcastle IMATT

Gateshead CATS

Sunderland CATS

Seaham CATS

North Tyneside IMATT

Northumberland IMATT

Diagnostic Imaging Quality Audit: Evaluation of Compliance with Royal College Radiology

Guidelines: MRI referrals 2014-15

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Camden CATS

Newcastle IMATT

Gateshead CATS

Sunderland CATS

Seaham CATS

North Tyneside IMATT

Northumberland IMATT

Diagnostic Imaging Quality Audit: Evaluation of Compliance with Royal College Radiology

Guidelines: Xray referrals 2014-15

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What does this tell us about patient safety?

For all services where referrals for diagnostic tests are completed as a part of clinical

care, 96% of X-rays and 90% of MRIs consistently meet Royal College of Radiology

guidelines. This has been fed back to individual clinicians and where required training

and development to support their clinical care delivery has been completed. (Graphs

above show more detail)

Our physiotherapists and doctors diagnose serious pathology very well and manage

their care very quickly as per NICE guidelines, with 94.7% of patients being referred

for the investigation of choice on the 1st appointment in Newcastle IMATT contract for

example

Clinical ‘paper triage’ is highly effective when completed by advanced trained ESP

physiotherapists for MSK services when good guidelines and training support this

activity.

Infection control standards of sharps disposal and segregation of healthcare waste

are strongly embedded in practice (as outlined by NICE and Health & Safety

Executive)

Although we meet targets for response rates for completing written responses for

patient complaints very effectively, the quality of some patient written complaint

responses could be improved in the company and training for staff is required. This is

now being planned

The documenting of clinical consent for treatment has been excellent in all contracts

across the company

Utilising standard audit systems allows for internal benchmarking to enhance our

internal quality assurance. This has proven to be effective to focus quality

improvements and recognise and reward excellent quality within our teams

0%

20%

40%

60%

80%

100%

MRI Xray

Diagnostic Imaging Quality Audits: Evaluation of Quality improvements over time

2013 to 2015

2013-14 2014-15

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Providing local clinical leadership is essential for quality assurance.

Evidence of Clinical Effectiveness

In order to provide quality clinical care which meets national standards, it is important to

continually determine whether the treatments provided are clinically effective in order to

provide optimum improvement and recovery of patients, whist ensuring we are seeing the

“right patient, in the right place, at the right time”.

At Connect we measure clinical efficacy and importantly throughout this year have focused

on key successes including:

Use of patient reported outcome measures (PROMs),

Serious diagnoses evaluation

Priority appointment scheme development.

Patient Reported Outcome measures (PROMS)

Measuring and recording the outcomes of patient’s clinical care is important for everyone-

patients, clinicians, managers and commissioners of services. At Connect, we want to be

improving patients’ quality of life and measuring how well we do this is essential to

confirming we are clinically effective.

In MSK physiotherapy, the PROM of choice is EQ5D which is a ‘validated’ PROM

designed to evaluates patients ‘quality of life’ before and after any clinical intervention.

EQ5D is the outcome measure of choice for MSK physiotherapy as championed by NHS

England (Department of Health) and the Chartered Society of Physiotherapy (CSP).

At Connect, we are developing our capabilities to consistently and regularly report on

PROMs using EQ5D and have, over the years, piloted use of EQ5D in a number of

services, to determine clinical effectiveness in all its contracts.

Some of the EQ5D data that has been produced from pilots recently have shown us

interesting results and in one pilot in Newcastle West Physiotherapy, this demonstrated

the following over a 3 month period post physiotherapy treatment:

0.4369

0.6316

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Baseline 3 Month Follow Up

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What does this tell us about clinical effectiveness?

This change in EQ5D score denotes a significant improvement in quality of life

with even a short period of physiotherapy treatment and intervention in community

setting

We will continue to grow and internally benchmark our services against scientific

evidence and contribute with any HQIP initiative regarding this, as they develop

the National Audit Database for this type of healthcare service.

Serious diagnoses evaluation

When a patient presents with a muscle or joint problem to their physiotherapists or to their

specialist clinician in a CATS clinic, it is recognised that an important part of the clinical

consultation is to screen for serious diagnoses and redirect these patients for either

tests/investigations, to a more specialised provider or to emergency care.

Connect have completed audits of confirmed and suspected serious diagnoses in

patients referred in 2014/15, in order to learn more about their service delivery but also to

ensure that these patients when diagnosed, are managed appropriately in line with

national clinical guidelines (such as those by NICE).

Below is a breakdown of the services in the North of England called NE CATS & IMATT

in 2014-15 and the types of confirmed serious diagnoses that were made in the service:

In addition, 88.7% of patients with confirmed serious diagnoses were referred by

our clinicians and ‘imaged’ on their first appointment (100% were sent for a tests

or investigation within 2 appointments)

What does this tell us about clinical effectiveness?

Our clinicians are making sound clinical judgement on serious diagnoses from

the patients they are seeing and are not missing these in consultations. We

can take confidence from this that we are treating the right patients with the

right care at the right time

NE CATS & IMATT 2014: Confirmed Serious Diagnoses: Break down of diagnosis type

Fracture (18) Malignancy (23) AVN (3)

Infection (5) Medical such as AAA (3)

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Clinical care was moved on very swiftly for all patients with a serious

diagnosis

Clinical triage was incredibly effective- All of these confirmed serious

diagnosis patients, had no indication of red flags (ie worrying sinister features)

when assessed by their GP prior to referral to Connects MSK specialist

clinician

Some hospitals had poor timescales for returning investigation reports to our

Referral Management Centre with a range from same day to 22 days. We

have identified this with local hospital radiology departments and are working

closely with them to improve this

There is an absence of a Metastatic Cord Coordinator (MCC) in the North

East of England. This role is outlined as essential role outlined by NICE MCC

Guidelines. Connect have and continue to work with Commissioners of NHS

services to help improve this. It is interesting to note that in our Nottingham

MSK contract, there is this MCC coordinator in place and in this service;

these patients have a more streamlined source of care. Connect are sharing

these lessons learned with local commissioners to help inform important

service design changes

Priority appointments

Earlier in late 2014, a patient made a complaint about their experience in one of our services. On evaluation of the main issues about his care, we realised that actually his care could have been moved on to a more specialist service quicker if we had a better Patient Prioritisation Procedure. When we reviewed this alongside other incidents and complaints, we noted

improvements could be made if we offered “Priority appointments” to patients for

quicker/better healthcare access.

This was particularly relevant if they are having a more significant problem such as:

- The patient is off work due to their MSK problem

- The patient is significantly affected by this problem interfering with their life

considerably

- Their condition looks clinically more urgent and requires more priority

assessment

- After surgery rehabilitation / treatment is required within in certain timelines

We completed the pilot and have since extended this across the company and into all

other contracts, during 2014/15, with great success noted. This means that we can

respond more effectively to meet patients’ needs and improve quality and

effectiveness of care.

What does this tell us about clinical effectiveness?

After the pilot was completed, we conducted an evaluation of the impact of this

change within appointment booking systems and determined the following:

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100% of patients were offered an appointment from ‘same day’, to up to 5

days from receiving referral

100% of the patients who were identified as Priority were clinically appropriate

for priority status, as evaluated by Clinical Lead Physiotherapist

58% of priority patients required urgent tests or investigations

15% required urgent hospital referrals

Patients requiring non-surgical treatment, were referred much quicker than

previous models of working

7% of the patients who had tests had confirmation of serious diagnoses

(which is higher than the rate of serious diagnoses nationally for audits). This

means we identified these patients and directed their care more effectively

Of these serious diagnoses, the care was moved on considerately quicker

than if they remained in previous care models

By offering Priority or urgent appointments for patients, we can signpost patients to “the right person, at the right place, in the right time”

We provided feedback to local GPs who made these referrals to our services to help educate GPs on more appropriate signposting of care and worked collaboratively with Commissioning GP leads to help consider educational topics for local GPs with this audit data in mind. This has proved to be not only clinically effective for better care, but also did not have a negative cost implications on the service either as all of the appointments were used, resulting in no wasted appointments.

Measuring Patient Experience

Providing excellent patient-centred care is at the heart of Connect’s clinical philosophy of healthcare as well as its clinical strategy. This means providing a ‘positive patient experience’ as well as good clinical outcomes of care.

An important part is ‘listening to patients’, obtaining feedback and also providing mechanisms for regular canvasing of patient experience (good and bad) including concerns and formal

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complaints. Importantly, it’s what’s done with this information, how it is used to inform service design changes and what improvements can be made to service delivery that optimises the quality of care and experience of patients.

Over this past year, Connect have invested in a patient experience measures (PREMs) survey

& collection systems known as Customersure, which can be accessed by patients either on

line, via email or on paper. This has also been aligned with the redeveloping of our approach

to recording and evaluating Patient Concerns & Complaints.

Patient experience measures (PREMs)

Across all of our contracts we standardly utilise a patient feedback survey, which is short and quick to complete. The questions address the key components of quality healthcare including Friends and Family rating. Patient feedback forms are distributed via post, face to face and via an online application to meet patient needs. For the financial year of 2014/15, we have had a response rate for NHS services around 4-11% over the year and are aiming for a target of 25% in line with national data from NHS England on patient satisfaction surveys. Below is a summary of the quality marks the patients have provided evidencing consistently high marks over this year:

We also regularly complete additional patient feedback for contracts which aim to address

questions of interest to local NHS Commissioners. The feedback and response rate has

been excellent. An example of results from feedback on our Sunderland Community MSK

service in September 2014 are listed below:

97% of patients stated the physiotherapist had listened to concerns and

answered their questions

96% of patients felt they were definitely kept informed and involved in decisions

about their care and treatment

99% of patients understood the aim of the treatment given

94% rated their experience as good to excellent

We have used this data from patients’ voices and feedback forms to produce action plans,

service improvements and feedback to front line clinical and administrative staff. This patient

0

2

4

6

8

10

Patient Experience Measures (PREMs) Quality Measures

Year to date 2014/15

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data has been evaluated over time and we made some significant positive changes by

improving our services including:

Improving signage in venues

Increasing choice of female or male clinicians

Ensuring our administrative staff offer more choice of locations to patients

(improved from 89-94%)

Addressing some training needs in relation to communication skills for clinicians

We have seen improvements in patient experience measures as a result of these changes

and also a reduction in patient complaints that had been trends we had seen previously.

What does this tell us about patient experience?

The vast majority of patients have a very good/excellent experience with the

services Connect and its staff offer

Listening to patients helps improve quality of service delivery by identifying

themes from patient experience measures to reinforce excellence in practice but

also to re-evaluate and redesign portions of the service by using service users’

feedback

This ‘Continuous Improvement’ approach at Connect not only improves quality of

care delivered, but also continues to enhance the experience of the patients in

the service.

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Part 3 Key Development & Improvement Priorities for 2015/16 In line with our Clinical Strategy we have identified some key development & improvement priorities for 2015/16

3.1 Improve Complaints & Concerns Reporting &

Management

Connect’s philosophy on complaints management is to investigate and resolve all complaints effectively, in the shortest time possible, with candour and transparency. This includes carrying out a full investigation which is focused on resolution of the concern or complaint, where possible to the satisfaction of the complainant, whilst being entirely fair to the staff involved. This will involve a verbal or written explanation to the complainant and an immediate apology where called for.

We have robust systems and processes to manage complaints and concerns from patients and generally do so very well. We continue to invest in the skills of staff and managers to resolve concerns and complaints effectively.

Connect are aware that there are some areas for focus and improvement regarding how concerns and complaints are reported and managed including:

Improved ability for all staff to locally resolve and manage patient concerns at the source to provide local immediate resolution – we are investing in consultation and communication skills training

Improved consistency of quality of written complaint responses – we are investing in training for managers

Improved data reporting regarding incidents and complaints- we are looking at ways of developing our reporting capabilities to be more efficient and effective and to allow local managers to self-monitor, capture data and trends better

Within this year, we have commenced redesign of our policies and procedures and have already initiated some training for managers and front line staff. Where this has been put in place, we can already see an improvement in the quality of written complaint responses and also of the ability of local teams to resolve local issues more effectively and with greater patient satisfaction measures from PREMs.

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3.2 Strengthen our Clinical Leadership Structure Connect has formally structured its clinical leadership to ensure a safe and high quality service is provided throughout. Our defining principle is that responsibility for clinical governance starts with clinical teams within any local service and cascades upwards until reaching the senior, responsible clinicians who are the National Clinical Manager (physiotherapist) and the Medical Director (Consultant). In 2015/16, the structure outlined below will be implemented across all Connects services & regions:

At the base, governance is essential in everything clinicians do and is supervised by clinical team leaders who will be responsible for a group of clinicians in their sub-specialty area. Information is cascaded upwards through a series of reports and meetings. The team leaders meet with the regional lead physiotherapist/doctor at the clinical steering groups. This restructure will afford more ‘local accountability’ as well as overall improved visibility and reporting on Clinical Governance

3.3 Maintain & Develop Accreditation & Registration to improve Quality Connect currently does not meet the threshold of requirement for a Monitor Licence. In 2015/16 this threshold will be reached and Connect intends to register, be monitored by and be accountable to Monitor. In addition Connect is considering achieving BS ISO 9001 Quality Management Standards. We believe both of the above will further drive valuable improvements in our Quality systems and processes throughout the business.

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3.4 Clinical Outcome (PROMs) development & EQ5D roll out EQ5D is the standardized ‘measurement of effectiveness of physiotherapy’ supported by the Chartered Society of Physiotherapy (CSP), which they are keen to promote. The CSP says the EQ-5D-5L measure is non-contentious, easy to read and understand, validated and takes approximately two minutes to complete.

We have struggled as a multi-provider company in the community, to deliver EQ5D (now our clinical outcome measure of choice) consistently across all services, in a manner that is efficient, as well as effective. Within this financial year we be investing in improved systems as well as the appointment of a Project Manager to oversee PROMs development and implementation the local Community setting and also nationally as a multicentre organisation. We will internally benchmark our services against scientific evidence and contribute with any HQIP initiative regarding this, as they develop the National Audit Database for the type of healthcare service we deliver

3.5 Our ‘Fit For Future’ Programme ‘Fit for Future’ is one of the main programmes of work being undertaken by Connect,

underpinning the organisational growth & development strategy and is based upon three key

themes:

Standardise – delivering our services as efficiently as possible

Develop – improving upon the strong foundations we already have

Innovate – maintaining competitive advantage

Standardise

One core business proposition

Rationalisation of business systems

Rationalisation of patient pathway

Referral Management Centre (RMC) - across the business

Multidisciplinary teams throughout

Consistent use of technology

Develop

Build on core business proposition

Continually improve business processes

Staff skill base

Patient/ customer access channels

Understand how existing technology can improve services

Innovate

Our People - providing multi-disciplibary care

Our Processes - new & efficient ways of delivering quality services

OurTechnology - cutting edge technology

Our Products/Services - that solve modern healthcare problems

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Fit For Future Developments and Innovation

People o Investment in People to meet demands of changing services (shift in secondary

care activity and increase in prevention) o Clinical skills development with Shared Decision Making (Improving

consultation skills) o Leadership skills development

Processes

o Identify and implement process improvements & efficiencies o Outcome measurement (PROMS)

Technology

o Implement New IT platform o Enhance Patient Self-management & Prevention support

Products/services

o Exercise-based rehabilitation o Biopsychosocial Model o Pain Management o Minor Surgery

Significant investment in our Fit for Future programme will be made in 2015/16, which will

benefit patients, staff and commissioners, ensuring that we are the Number 1 Quality MSK

provider in the UK and the employer of choice.

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Appendix 1

Glossary of Terms Adverse incidents Any event or circumstance arising that could have or did lead to serious unintended or unexpected harm, loss or damage. Care Quality Commission (CQC) The Care Quality Commission is the independent regulator of health and social care in England. It regulates health and adult social care services whether provided by the NHS, local authorities, private companies or voluntary organisations. Visit: www.cqc.org.uk Chartered Society of Physiotherapy Chartered society of physiotherapy (CSP) is the professional governing body for physiotherapists as a profession. Further they are the trade union for physiotherapists. http://www.csp.org.uk/ Clinical audits A systematic process for setting and monitoring standards of clinical care. ‘Guidelines’ define what the best clinical practice should be, ‘audit’ investigates whether best practice is being carried out and makes recommendations for improvement. Commissioning for Quality and Innovation (CQUIN) A payment framework that has been a compulsory part of the NHS contract from 2009/10. It allows local health communities to develop their own schemes to encourage quality improvement and recognise innovation by making a proportion of NHS service provider’s income conditional on locally agreed goals. Community services Health services provided in the community, for example health visiting, school nursing, community nursing, special dental services, physiotherapy, podiatry (foot care). Healthcare Healthcare includes all forms of healthcare provided for individuals, whether relating to physical or mental health Health care and professions council (HCPC) Health care and professions council (HCPC) are the professional regulator for physiotherapists as an allied health professional. They are responsible for registration and re-registration for licence to practice for physiotherapists and ensure that all registered physiotherapists adhere to the Standards of proficiency (Fitness to practice). Further the HCPC approve the quality of training programmes and maintain a register of professionals who have met the proficiency standards to practice. http://www.hpc-uk.org/ HQIP Healthcare Quality Improvement Partnership. Visit: http://www.hqip.org.uk/ Musculoskeletal (MSK) Parts of the body involved with movement and function, such as bones, joints, muscles, ligaments, tendons, nerves.

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National Institute of Health and Clinical Excellence (NICE) NICE provides guidance, sets quality standards and manages a national database to improve people’s health and prevent and treat ill health.NICE makes recommendations to the NHS on:

New and existing medicines, treatments and procedure

Treating and caring for people with specific diseases and conditions

How to improve people’s health and prevent illness and disease Visit: www.nice.org.uk National Patient Safety Agency (NPSA) The National Patient Safety Agency is an arm’s-length body of the Department of health, responsible for promoting patient safety wherever the NHS provides care. National patient surveys The National Patient Survey Programme, coordinated by the Care Quality Commission, gathers feedback from patients on different aspects of their experience of recently received care, across a variety of services/settings. Patient Reported Outcomes (PROMs) PROMs assess the quality of care delivered to patients by measuring ‘outcomes’ or the ‘tangible effect of care’ on the patient. Physiotherapy Registered and qualified practitioners skilled in the assessment and treatment of conditions relating to the human body, that limit or impair movement & function (temporarily or permanently). Research Clinical research and clinical trials are an everyday part of the NHS. The people who do research are mostly the same doctors and other health professionals who treat people. A clinical trial is a particular type of research that tests one treatment against another. It may involve either patients or people in good health, or both. Root Cause Analysis Root Cause Analysis (RCA) is the structured approach to identifying the factors which resulted in an incident. The root causes are the fundamental issues which lead to the incident happening and must be addressed to improve the delivery of care. Safeguarding A term used in conjunction with measures that are taken to protect, safeguard and promote the health and welfare of children and vulnerable people, ensuring they live free from harm, abuse and neglect. Secondary Uses Service (SUS) The Secondary Uses Service is designed to provide anonymous patient-based data for purposes other than direct clinical care such as healthcare planning, commissioning, public health, clinical audit and governance, benchmarking, performance improvement, medical research and national policy development. Serious Untoward Incidents (SUI’s) Essentially serious incidents are which cause (or have the potential to cause) the most harm either to individuals (staff, service users, visitors, contractors, others) or to the organisation. These include unexpected deaths; injuries causing admission to hospital; major and

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permanent physical or psychological harm; large-scale theft or fraud; outbreak of disease; major fire or flood; etc. Further Information and Feedback If you would like any of the following:

to give us feedback on any aspect of this Quality Account

a hard copy of this quality account

a copy to read it in a different language

to talk to someone about your experiences of our community MSK services

to find out more about how to access our services

please email customerservices@connectphc.co.uk or phone 01912504580 Central Office: The Light Box, Quorum Business Park, Benton Lane, Newcastle upon Tyne, NE12 8EU