Agenda item

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) has been invited to present a report on Musculoskeletal (MSK) Services in Oxfordshire. The Committee has previously been involved in scrutiny of MSK services and has commissioned a report on this area with a view to receive an update on the current state of MSK services for local residents/patients.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) was invited to present a report on Musculoskeletal (MSK) Services in Oxfordshire. The Committee had previously been involved in scrutiny of MSK services and had commissioned a report on this area, with a view to receive an update on the current state of MSK services for local residents/patients.

Matthew Tait (Chief Delivery Officer BOB ICB); Ansaf Azhar (Director of Public Health at Oxfordshire County Council), and Connect Health Officers Tony Collett, Mike Carpenter, and Suraj Bafna attended to answer questions the Committee had in relation to the MSK Services in Oxfordshire report.

The Associate Director and the Connect Health officers discussed the initial challenges when they assumed the contract. These included staffing shortages, a backlog of 19,000 patients, and the need to rebuild stakeholder relationships.

By February 2025, all service lines except pelvic health were within the target wait times of six weeks. The pelvic health service had a wait time of ten weeks. The service was nearly at its full staffing level, with only a 0.6 full-time staff shortfall. Delays in Health and Care Professions Council (HCPC) registration affected the start dates for new pelvic health clinicians.

The team conducted three community engagement events and planned to attend more, including those organised by the Oxfordshire Play Association. They arranged for Healthwatch to assess their services in April and May. A five-year plan to address health inequalities was implemented at the beginning of 2025, with quarterly updates provided.

The team engaged with primary care through network group meetings, stakeholder meetings, seminars, and newsletters. They also collaborated with secondary care teams, including rheumatology, orthopaedics, radiology, and gynaecology, to streamline pathways and address wait times. Contact with independent providers like Cherwell Hospital was maintained to help manage wait lists and alleviate service pressures. Finally, ongoing efforts were made to develop a unified model across the three counties (Buckinghamshire, Oxfordshire, and West Berkshire) to ensure consistent service delivery and mitigate postcode disparities.

Ansaf Azhar, Director of Public Health, joined the meeting at this stage.

Members asked about the innovative delivery models mentioned in the report, specifically how these models and the use of technology and Artificial Intelligence (AI) have contributed to reducing waiting lists. They suggested that if these models were effective, they could potentially be applied to other areas to cut down waiting lists.

The Associate Director, along with the Connect Health Officers explained that the innovative delivery models mentioned in the report included the use of technology and AI to manage musculoskeletal conditions. These models aimed to triage patients effectively, allowing those with less complex issues to self-manage with targeted advice and exercises. This approach freed up appointments for more complex cases, contributing to reduced waiting lists. The effectiveness of these models suggested that they could potentially be applied to other areas to cut down waiting lists.

Members had highlighted concerns regarding the long waits for rheumatology and orthopaedics, acknowledging these as serious long-term conditions. They questioned the effectiveness of the diagnosis process since only 10% of referrals proceeded to orthopaedics or rheumatology. They also sought clarification on how the referral process functioned for more complex patients.

Officers recognised the significance of these long-term conditions. It was stated that the diagnosis process was effective, as only 10% of referrals required forwarding to orthopaedics or rheumatology. This was attributed to the comprehensive assessment and treatment provided by the Tier 2 service, which included advanced practitioners skilled in managing complex cases, conducting diagnostics, and providing treatments such as injections. The referral process for more complex patients involved a detailed triage to ensure all necessary information and prior approvals were secured before referring them to secondary care.

Members raised questions about Musculoskeletal (MSK) services in the southern parts of the county, particularly at Wantage Hospital. They discussed improving service distribution, especially in the southern regions, and enhancing recruitment and retention within the MSK workforce. The conversation also touched on demographics and the aging community.

Connect Health officers stated that efforts were underway to improve MSK service distribution. Wantage Hospital continues to provide physiotherapy services, with active recruitment to maintain staffing levels. Recruitment measures include travel time and mileage coverage for clinicians and collaboration with Oxford Brookes University for student placements. The distribution of services is data-driven, ensuring appropriate coverage based on patient postcodes. Addressing rural inequalities and catering to the growing aging population remain priorities.

Members inquired whether the organisation recognised the importance of supporting staff once they were in post to ensure they felt valued and rewarded. They sought information on the HR measures being implemented to maintain staff retention and prevent employees from feeling overwhelmed by their workload. Officers responded that regular feedback was solicited from staff, and efforts were made to enhance the working environment. Initiatives included team-building activities, allocated time for personal development, external funding for courses, and well-being surveys. Additionally, the organisation provided administrative support, mental health resources, and opportunities for internal training and upskilling. These measures aimed to ensure that staff felt valued, rewarded, and not overburdened by their responsibilities. 

Members inquired about the organisation's involvement in planning and development discussions to ensure that future service sites are adequately planned for local communities. They asked if the organisation had been consulted regarding their requirements for future developments, particularly in regions with significant population growth. The Associate Director and Connect Health Officers confirmed that the organisation participated in these discussions to guarantee that healthcare needs are considered in planning. Efforts were made to attend consultations and advocate for healthcare integration in future development plans. The organisation sought to engage with local authorities and other stakeholders to address the needs of expanding communities.

Members inquired about the reasons for not meeting three key performance indicators (KPIs), and the measures being taken to address this issue. Connect Health Officers clarified that the organisation had not met three KPIs related to routine access times, urgent access times, and contacting patients within 10 working days of receiving a referral. The reasons included actions by the administrative team and clinicians, such as booking routine patients into urgent slots. Measures to improve the situation involved modifying these actions, monitoring the use of urgent slots, and implementing a plan to contact patients sooner. Additionally, the organisation considered alternative methods, such as texting patients, to improve contact times.

Members inquired about the provision of long-term support and pain management for MSK patients, particularly those experiencing chronic or long-term pain, and how occasional outpatient appointments translated into ongoing support and pain management. Connect Health Officers explained that long-term support and pain management for MSK patients, especially those with chronic or long-term pain, were delivered through a low-level pain management programme. This programme included a team of senior pain clinicians and advanced pain practitioners who provided assistance to patients with mild psychosocial factors impacting their pain.

For patients suffering from severe pelvic pain, urgent appointment slots were made available to ensure they received timely care. The organisation recognised the need to enhance support for patients awaiting appointments and committed to reviewing and improving their waiting well messages and resources. Additionally, efforts were being made to streamline pathways and collaborate with various stakeholders to better support patients with comorbidities.

Members asked about the impact of pelvic pain, referencing a national survey by the Pelvic Pain Foundation, and inquired to what extent the service was collaborating with key partners such as the Pelvic Pain Foundation to support patients. Connect Health Officers indicated that pelvic pain significantly affects women, often resulting in severe pain, inability to work, and challenges in managing family responsibilities.

A national survey by the Pelvic Pain Foundation provided evidence of these challenges. The service acknowledged the importance of collaborating with key partners and mentioned ongoing collaborations with various NHS stakeholders. It was noted that there had not yet been engagement with the Pelvic Pain Foundation. The service committed to exploring this potential partnership to enhance support for patients waiting for care.

Members inquired about handling negative feedback, especially regarding pelvic health, and steps taken to improve patient interactions. Connect Health Officers explained that complaints were investigated through contact with patients and review of clinician notes. Trends were identified via thematic analysis and findings were reported to senior leadership and the ICB. Lessons from complaints were shared with the team through meetings, training, and individual sessions. The service maintained a low complaint rate and received high positive feedback, showing overall patient satisfaction.

Members inquired about how the service was collaborating with diagnostic physiotherapists available at every GP surgery through primary care networks. They also questioned the coordination of ongoing care for MSK patients between GP surgeries and specialist services/consultants, as well as the key challenges involved.

Connect Health Officers detailed that the service worked closely with diagnostic physiotherapists (First Contact Practitioners or FCPs) available at GP surgeries through primary care networks. They conducted seminars and collaborated with Integrated Care Boards (ICBs) and rheumatology teams to support FCPs and GPs. Additionally, they implemented a GP engagement plan to identify and address challenges faced by practices with low referral rates. Coordination for ongoing care of MSK patients between GP surgeries and specialist services/consultants involved regular meetings and direct communication to streamline pathways and tackle any issues. Key challenges included variations in FCP providers and ensuring seamless integration of services.

The Committee AGREED to issue the following recommendations:

1. To address variances around the county, with a view to residents being able to access local MSK services more swiftly.

2. To continue to develop further collaboration with GPs and other services to improve MSK services. It is recommended that efforts are made to reduce the number of steps (and time) required to access MSK services.

3. For efforts to be made to create improvements to pelvic health outcomes. It is recommended that there is engagement with the Pelvic Pain Foundation around support for those who are waiting for support.