Providing a virtual multidisciplinary service

Patients with complex, chronic musculoskeletal (MSK) conditions such as back pain, knee pain and arthritis often see multiple specialists across primary and secondary care.

Patients would benefit from a more joined up and multidisciplinary approach to diagnosis and management. This would help to avoid overtreatment and improve patient experience.

Situation

There are approximately 600,000 people in the Berkshire West Integrated Care System (ICS).

Before the ICS introduced the Integrated Pain and Spinal Service (IPASS), an audit took place. It revealed that 20 patients had used multiple services to get a diagnosis for the same condition. This resulted in around £500,000 of assessment, investigation and interventions costs.

Aspiration

Clinical teams across rheumatology, physiotherapy, neurology, pain management and orthopaedics wanted a more efficient, accessible way to share patient information securely.

They wanted to provide an expert multidisciplinary opinion on complex MSK cases without the need to travel.

Solution and impact

IPASS brings specialists from across primary and secondary care into 1 meeting place in the community. This includes:

• orthopaedics
• pain management
• rheumatology
• physiotherapy
• neurology

Clinicians, including first contact practioners and specialist physiotherapists, can use IPASS to book a virtual multidisciplinary team (MDT) clinic to discuss rheumatology cases.

The virtual MDT allows clinicians to discuss the patient's care, covering:

• investigations
• onward referral
• their management plan

Before the COVID-19 pandemic, the majority of MDT meetings were face-to-face which incurred travel for all clinicians. Around 5 to 10% of MDT meetings were conducted virtually using IPASS.

The pandemic meant rheumatology MDT discussions were quickly moved to Microsoft Teams. 100% of these are now conducted virtually.

Functionality

• A virtual MDT forum is available to discuss clinical cases.
• Screensharing makes it possible to share information, like images and patient records, amongst different clinical teams in real-time.

Capabilities

• Patients can be seen at the right place at the right time and prevents unnecessary referral to secondary care.
• Patients receive expert input from multiple clinicians in a more joined up process using a multidisciplinary approach. This avoids overtreatment.
• Teaching, education and training can be done virtually.

Scope

• The virtual MDT model can be used across specialties to provide high quality, patient-centred care. It’s not restricted by location.
• A broad range of first contact practitioners, such as physiotherapists working in primary care, can be invited to virtual MDTs. This also enables training.

Key learnings

• Engage with all stakeholders needed for the MDT meeting. All relevant clinicians should input into a patient’s care for a more holistic approach. It should not be a secondary care initiative.
• Agree common goals with your MDT, for example, what you’re trying to achieve with a virtual MDT. This creates a shared purpose for the group.
• Costs for managing long-term pain are reduced through regular meetings with the MDT and intervening earlier where needed.

Key figures and quotes

• The service has been able to see 1,500 patients using the same amount of resources as the 20 patients revealed in the audit.
• Patients in Berkshire suffering high levels of pain have had their wait for a specialist appointment reduced from 9 months to just 1, saving the NHS more than £200,000 a year.

“It’s a very good model and I think it shortens patient journey, prevents unnecessary referrals to your service and hence is cost-effective.”

IPASS clinician 1

“It has been very beneficial and time efficient for me. In addition, the patients feel well supported when I discuss that I have had your support in the onward management plan.”

IPASS clinician 2

“We have definitely found this model really useful from the IPASS side.”

IPASS clinician 3

Find out more

IPASS patient Youtube videos

IPASS shared learning on NICE website

Pain patients’ hospital wait reduced by 90% saving NHS £200,000 a year

A new way of delivering MSK pain service webinar on ARMA website

Key contact

Dr. Antoni Chan, Consultant Rheumatologist and Physician, Royal Berkshire NHS Foundation Trust

antoni.chan@nhs.net

Niall Lynch, IPASS Spine Manager, Advanced Physiotherapy Practitioner, Berkshire Healthcare NHS Foundation Trust
niall.lynch@berkshire.nhs.uk