Healthcare delivery
Cutting waiting times for musculoskeletal conditions
Marie Loizides, associate director of performance analytics at Barking, Havering and Redbridge University Hospitals NHS Trust, explains how the North East London Musculoskeletal (MSK) Alliance has improved the quality of referrals and significantly slashed waiting times.
For many patients the chronic pain and fatigue caused by arthritis, or other musculoskeletal (MSK) conditions can make getting out of a chair, sitting in a car, or catching the bus to an outpatient’s appointment difficult. So being referred for the wrong treatment can be devastating. As a qualified physiotherapist, I’ve witnessed first-hand what a blow being referred to the wrong clinician or for the wrong kind of treatment can have on a patient. As one osteoarthritis patient puts it: “What happens when my body breaks down happens not just to that body but also to my life which is lived in that body. When the body breaks down so does the life.”1
It is an ongoing battle for NHS Trusts to tackle the elective care backlog and a multipronged approached is needed. Automating triage can save time for GPs and consultants and improve the patient experience and outcomes by speeding up delivery of care. However, with the current length of waiting lists, the reality of self-managing and living with chronic pain, fatigue, loss of mobility and stiffness is affecting the lives of over 20 million people across the UK2 2019.3
up from 17 million in Having arthritis or another MSK condition
can severely reduce the quality of the person’s work and personal life. Depression is four times as common among people living with pain compared to those living pain free and, for the last ten years, MSK conditions have been cited as one of the top two reasons for workdays lost.4 For the NHS too, treating and supporting people with these conditions can have a far-reaching impact on financial and service delivery. MSK conditions account for one in seven GP consultations and were the most recorded reason for hospital admission in 2019/20.4
Increasing risk of MSK related conditions
As the UK population ages it brings with it additional challenges for the health service. Although MSK conditions can affect anyone at any age, the risk of developing one increases as you get older.4 By 2045 there are expected to be 3.1 million
people over the age of 85, which will equate to 4.3% of the UK population. This is almost double the amount of people in that age range than in 2020.5
By 2035, the number of people aged 65
and over living in England with two or more long term conditions is forecasted to rise from 54% in 2015 to 68%.4 There is also increasing evidence that the number of people living with two or more conditions is becoming the norm in older age groups and for those living in disadvantaged communities.6
Since we digitalised the MSK referral process, we have reduced patient waiting times by over a month, as triaging cases takes half the time it used to take.
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People on lower incomes and living in more deprived areas are also more likely to suffer with arthritis or another MSK condition3
and
chronic pain has been found to disproportionally affect ethnic communities.4
Our musculoskeletal
(MSK) services cover a large population of approximately 800,000 living in North East London. The area includes three of the most diverse London boroughs and is home to a wide range of communities.7 People living in more deprived areas or who
are from a ‘more disadvantaged social class’ are more likely to develop multimorbidity before age 50 compared to those who are from a ‘less socially disadvantaged class.’4
In Barking and
Dagenham there is a higher than the national average number of people aged 45 plus with hip and knee osteoarthritis and who are physically inactive due to MSK conditions.8 Like many areas of the health service, our patients were experiencing varying quality of care across the boroughs due to organisational boundaries and historical funding. We are working hard to make sure that all our patients can receive the treatment they need as soon as possible and have explored many ways to tackle the backlog. Our innovative approach, holding
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