03 December 2009
SystmOne Supporting Kirklees Musculoskeletal Service
The Musculoskeletal Service, based in Dewsbury Primary Care Centre in Kirklees PCT first started seeing patients in July 2007 and went live on SystmOne in early August 2007. The service sees approximately 45 new patients a week, and currently has three full-time clinicians.
Chris Creaghan, Clinical lead and Musculoskeletal Practitioner has been at the forefront of SystmOne usage in the service, exploring its capabilities and encouraging staff to use it to drive the service forward. He says, "Our entire existence as a service has been on SystmOne really. When we were setting up the service, we knew we needed a new system and we had the foresight to look at SystmOne and think about what it could do and how it could make our clinical lives easier. We are trying to create the most cost-effective, clinically effective service and SystmOne is helping us to do that. After more than two years of entering data onto SystmOne, we can now use it to justify our service to commissioners. "
Chris Creaghan, Clinical Lead and Musculoskeletal Practitioner
Working with GPs
Chris continues, "In terms of sharing data with GPs, we started with a great advantage because of the good work done by the PCT in rolling out SystmOne to GPs in the area. We supply an MSK service to the North Kirklees area which covers 32 GP practices, all of whom are using SystmOne. We share records with the GPs so that everything that happens to the patient is available to us and to them, which is exactly how it's meant to be."
Everything that the MSK service does for a patient is recorded on SystmOne. Chris describes a typical consultation: "I saw a patient this morning and looked at her SystmOne record. I saw on the New Journal that we had previously made an assessment and a diagnosis, and that a Read code was recorded for the first appointment. I then performed an ultrasound scan and injection therapy, recorded that on SystmOne and produced a clinical letter using a mail-merge template. From a legal aspect, everything is there; from a clinical aspect, everything is there. I also ran off another letter from a template to send to the GP so that they are kept fully up to date with the patient's care."
Chris has engaged GPs in the area to improve the quality of referral letters to the MSK service. "With assistance from Robert Scott (Kirklees benefits realisation manager) we were able to upload a referral template for all GPs. It captures patient specific data such as current medication and active health problems; we get to see all relevant information at a glance and can quickly prioritise patient care."
Eightlands Surgery, which is also based in Dewsbury Primary Care Centre, have referred more than 200 of their patients to the MSK service. Dr Hicks, GP, says, "We use the MSK service because it's an absolutely excellent primary care service. Referring a patient to them is an alternative to a secondary care referral and the service has shorter waiting lists. We know the patient will get an excellent examination and receive effective treatment. The service staff are very helpful - they're at the end of the telephone at all times, and the patients are very happy because they're seen within the same Health Centre. The other major advantage of using the Kirklees MSK service is that they write in SystmOne. On the day that the patients are seen by MSK, we have all the information about what has happened. That is a unique feature with SystmOne."
Paperless
From the beginning, the service has used Read codes and auto-consultations and has become completely paperless. All letters and images are also attached to the patient record. Chris says, "I often attach images such as ultrasounds or nerve conduction studies to the record. We also have access to PACS at the hospital so we have a close focus of what happens with the patient."
Involving patients
The use of tools such as IT systems and orthopaedic models, like the skeleton, are helpful in explaining to patients what is happening to them. "Patients like us using the computer - showing them images such as X-rays is particularly useful. They understand what's going on inside their joints. We may not always be able to alter a patient's pain, but we can alter their perception of the pain."
Chris is proud of the treatment offered by the MSK service, and says that patients appreciate it too: "We can deliver an alternative to secondary care, performing assessment and treatment in a friendly, laidback and pleasant environment, with no car parking hassle, and no fragmentation of care - our patients always see one of three clinicians here. And as we run a complete service with everything in-house, we can offer a succinct and streamlined care pathway."
Keeping track
It isn't just the clinical functionality of SystmOne that suits the service, the administrative side is also beneficial as Chris explains, "The reporting side of SystmOne is incredibly useful. We have a good two years' worth of data and Read coding in the system and we know that our data is correct. So if people want figures, I can pull them off at the drop of a hat, which makes my life easier. If the MSK service was charging a tariff for services, it would be easy to run a report on a Read code for a particular service, for example 'Injections'. We use reports to find out how many referrals we've received, or to find out how many patients have gone for X-ray and then how many results have come back. If the two figures don't add up, we know results are missing. It speeds up the process and makes us absolutely on top of the game in terms of patient awareness."
Chris concludes, "All these reporting functions help us to check on a patient's progress and ensure appropriate care is delivered in a timely manner. It also enables accurate reports to be sent back to the commissioners; they need to know their money is being well spent."
Cost savings
The benefit of having a local service isn't just great for the patient, it provides a cost saving to the PCT too. As the MSK Service is led by extended scope physiotherapists, expenditure on these staff is less than consultation time purchased from secondary care. To ensure service quality is maintained, the MSK Service has access to an in-house orthopaedic consultant and a GP with specialist interests in musculoskeletal pathology. Collectively, patients are ensured of an accurate diagnosis and appropriate care but at cost saving to the PCT. Following diagnosis, 90% of all patients seen in the MSK Service are considered appropriate for definitive care that can be delivered within the Kirklees Community Health Care Service; keeping costs down, quality up and a continuation of clinical notes whilst achieving national aims of care closer to home.
Future
Looking to the future, Chris sees the service expanding, "We'd like to extend the service into the rest of Kirklees, and we'd like to bring consultants down into the MSK service on a regular basis. If we did this, the 10% of cases that we currently escalate to secondary care could be assessed by a surgeon here, so that patients receive even more of their care from the same service, and even more of their clinical care is documented in a single patient file."
