TO ICATS Worcestershire an outlier on spend on

T&O

ICATS • Worcestershire an outlier on spend on orthopedics in the West Midlands • ICATS now saves 2 Million (includes total cost of extra physio and the ICATS service) • Being reprocured currently

Previous ICATS Audit • Around 30% could have not been referred • Top 4 reasons - Try conservative treatment for longer - Try injecting the joint - Try physiotherapy - Ask patients opinion on possible treatment options

HIP PATHWAY INDICATED DIAGNOSIS CONSERVATIVE MANAGEMENT Analgesia/NSAIDS Physio XRay Better OUTCOME Trochanteric Bursitis OA Analgesia/NSAIDS Physio ? Injection Failed conservative Treatment + suitable for THR Better Discharge Complete Oxford Score Oxford score <30 clinically Oxford score >30 clinically If suitable for surgery Refer To ICATS Self Management Please insert name of GP providing Injection in each red GP Name box Discharge GP Name Failed conservative Treatment i. e. failed up to 3 injections Refer To ICATS Ax

INDICATED DIAGNOSIS CTS Trigger finger Dupytren’s Ganglia HAND / WRIST/ ELBOW PATHWAY CONSERVATIVE MANAGEMENT Mild/ Moderate or patient not fit for operation GP Name Analgesia / NSAIDS Splint Injection OUTCOME Nerve conduction studies (NCS) performed if diagnostic doubt orr before referral to ICATS for surgery No better Symptoms >6/12, patient would consider surgery Better Severe GP Name Physio not indicated NCS -ve Reassurance + Leave for 3 – 6 months Analgesia / NSAIDS Injection +ve Re-assess Contracture causing functional compromise or progression of contracture Better No better + Fixed deformity Discharge Better Discharge Neurovascular compromise Significant pain— ganglia at base of digit Mucoid cyts at DIP joint NCS -ve Re-assess +ve Refer To ICATS Refer To ICATS Referral to secondary care Please insert name of GP providing Injection in each red GP Name box

QP orthopedic Audit • GP referral to 1 st consultant outpatient • 592 referrals audited

Could anything else be done in primary care? Number No 79% Yes 21%

Interventions that might have allowed management in primary care Injection 39% Physio/podiatry 32% Conservative 18% other 8% X ray 4%

Possible interventions by area of the body Knee 29% Shoulder 13% Ankle and feet 12% Carpal Tunnel 9% Trigger finger 9% Hips 6% OA knee 6% Other 17%

Interventions following seeing a consultant where the GP audit suggested no alternatives Operation 70% Conservative 2% Other 17% Physio 1% Injections 6% No information 2% Orthotics 1%

Improving the orthopedic pathways • 1) How could you help more patients manage their condition conservatively? • 2) How could you make a more appropriate selection of patients for physio? • 3) How could you perform more/ a wider selection of joint injections? • 4) How could you ensure all of the doctors working in your practice are aware of the above?