What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

In Enfield (one of the most derived boroughs in London) there is significant pressure on NHS services and significant health inequality/ inequity of access. To address this, a new musculoskeletal hub opened in  2022, increasing primary and secondary care capacity. The next stage of the project is going to provide a brand new model of managing patients with complex musculoskeletal needs who utilise a large amount of finite resources. By identifying and managing these patients in a completely different way not only will their health outcomes improve, we will significantly increase capacity in other parts of the system such as A&E and GP services

This change idea has been developed through a collaboration across Enfield including primary care, community service and secondary care providers and commissioners. Most importantly we have undertaken extensive patient engagement to understand the issues around access and the needs of the local community in designing the intervention.

What does your project aim to achieve?

Objectives:

• Identify high intensity users of healthcare due to an musculoskeletal condition
• Using a multidisciplinary team, bring together the best of primary, secondary and tertiary care to develop innovative care pathways for these patients in a ‘virtual ward’ setting
• Improve health outcomes and equity of access
• Undertake research study into the impact and publish in a peer reviewed journal such as BMJ Open Quality

The intended beneficiaries are patients living with chronic pain who despite being seen different healthcare settings (A&E, community services and pain clinics) continue to have poor health outcomes and quality of life. By wrapping a multidisciplinary team (Occupational Therapists,  Dieticians, Psychologists, Physiotherapists and Nurses) around the patient, a personalised care approach meeting their needs will be delivered improving their health outcomes and participation in society. A recent ‘Versus Arthritis’ report notes ‘People with chronic pain were more likely to live in deprived areas’

How will the project be delivered?

The hub already has the operational and clinical resources in place to start working on the project. To ensure rapid change resulting in shareable learning, we need additional dedicated change expertise. The post will be embedded both in the musculoskeletal hub and supported by the RNOH’s Improvement and Transformation Team. This will allow additional QI and project management resource to be added to the project at crucial times and ensure input from the Trust’s established Patient Coproduction group and other service user groups.. As well as this in order to disseminate effectively we will utilise our clinical academic who is embedded in the hub to undertake the required data collection, patient interviews and qualitative/quantitative analysis.

How is your project going to share learning?

The RNOH has an excellent track record of disseminating its QI and research activities. In recent years we have published open access articles on improvement projects (e.g. Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative | BMJ Open Quality) and presented at national and international conferences. It is envisaged that this work would not only be shared through the Q-community but through research publications, national and international conferences and through various regional and national networks (e.g. solving together platform).