Transcript FRAMEWORK Providing Quality Service in a Cost Effective Way

COPS
Providing Quality Service in a Cost Effective Way
Department of Health
Musculo-skeletal Services
Framework
• A group of Chiropractors, Osteopaths,
and Physiotherapists in Swindon
(‘COPS’) was formed in response to a
Government initiative to ensure that
patients are seen, diagnosed, and
treated within 18 weeks.
(www.18weeks.nhs.uk)
Who are COPS?
• COPS is an association of local professionals
specialising in manipulation as their primary therapy.
• The association was formed to provide GPs with a
fast referral service for patients with acute back pain.
• The service will provide:
 For patients - 1º diagnosis, treatment,
rehabilitation exercise programmes and advice.
 For GPs – rapid access to an integrated package
of evidence based care within CSAG (Clinical
Standards Advisory Group) guidelines, in a 1° care
setting.
Management of Low Back Pain
“Manipulation provides better short-term
improvement in pain and activity levels than other
treatment options, resulting in higher patient
satisfaction”
Royal College General Practitioners (1999)
“Spinal manipulation, in the form of chiropractic,
osteopathy, or manipulative physiotherapy, followed by
a programme of exercise, provides significant relief of
symptoms and improvements in general health”
UK BEAM (Back Pain Exercise And Manipulation) trial,
Medical Research Council (2004)
Management of Low Back Pain
• “Consider manipulative
treatment within the first 6
weeks.”
• “Refer for
reactivation/rehabilitation”
GMC & BMA guidelines
• “… you must be satisfied that any health
care professional to whom you refer a
patient is accountable to a statutory
regulatory body …”
General Medical Council
• “… GPs can safely refer patients to
practitioners in osteopathy …”
British Medical Association
Quality & Governance
• Statutory regulation with
GCC / GOsC / HPC
• 4-5 year BSc degree
course
• Compulsory CPD.
• Approved by all major
Private Health Insurers
Are we safe?
• Red flag aware
• 50,000 manipulations with zero serious
adverse events; ~ statistically, at worst
a risk of 1 per 10,000 cervical
manipulations
• Transient impairment 1:50,000 (eg
fainting, dizzy or lightheaded)
• Reversible impairment 1:3.7million (eg
footdrop, sensory changes)
• Serious non-reversible impairment
1:5million.(eg CVA)
What are we proposing?
• To provide a specialised multidisciplinary
acute back pain service within 1° Care.
• The service would be based on the successful
Plymouth model.
Treatment Modalities
• Chiropractic or Osteopathic spinal manipulation,
unless contra-indicated.
• Caudal Epidural steroid injection, specific joint
injection with lignocaine and steroid, trigger point and
peri-facet injection.
• Acupuncture or acupoint stimulation
Benefits to GPs
•
•
•
•
Fewer consultations
Reduced cost
Prompt referral
Structured case
management
• Good
communication
Patient Benefits
• Choice
• Prompt appointments
• Diagnosis, treatment and
advice on initial
appointment
• Care close to home
• Continuity of care
• Reduced progression to
chronicity
• Facilities for disabled
patients
Where’s the proof?
1
• BEAM report
• Pilot Study into Cost
Effectiveness of
Chiropractic in Industry;
Taunton Cider
• Study into Cost
Effectiveness of
Osteopathy in a Swindon
Manufacturing Company.
Where’s the Proof ?
2
Study into Cost Effectiveness of Osteopathy in a Swindon
Manufacturing Company.
“The statistics show that overall, the osteopath is having an effect on
the workforce.”
Occupational Health Advisor
•30% of cases seen were acute for whom rapid attention generally
meant an early return to work, or no lost time.
•Quantifying productive time gained through the use of an osteopath
is difficult. However, a conservative estimate suggested that when all
costs were considered, 38% of the consultations were ‘free’.
Health and Safety Manager
Procurement
• “Any willing
provider” model.
• “Choose and Book”
• Proposal to PCT to
move funding from
2º care.
Ensuring value for money
• Value for money=
• Problem resolution=
• Reduced repeat GP
visits
• Reduced referrals to 2O
care.
• Use of G.P. questionaire
and Melzack analogue
scale for patients.
Referral Criteria
• Symptoms ‹ 6 weeks
• Trials of adequate analgesia
and mobility
• + one of the following:
• moderate/severe pain
• not making progress
• limited SLR
• neurological deficit
• off work
• restricted spinal movement
or scoliosis
The Revolving Door Patient
• Multidisciplinary
Sub-acute clinic to
be considered in the
future for nonimprovers.
And Finally
Never lend your car to anyone to whom
you have given birth - Erma Bombeck