We delivered a specialty-based rapid improvement across Humber Coast and Vale, improving patient outcomes, resulting in fewer referrals to secondary care

Background

In response to the continued operational pressures in elective care and following the success of the national 100-day challenges, NHS England commissioned NHS Midlands and Lancashire’s Improvement Unit to deliver a wave of specialty-based, rapid improvement challenges across the North Region.​

Rates of referral for magnetic resonance imaging (MRI) for low back pain were higher across the Humber Coast and Vale Health and Care Partnership (HCVHCP) area than the national average. There were concerns that many referrals may not be clinically required.​

Data for 2017/18 showed that all HCVHCP CCGs (except Scarborough and Ryedale CCG) spent at a higher rate on non-specific back pain than NHS RightCare peers, with 4,232 back pain inpatient spells. Highest users nationally of facet joint injections and spinal nerve root blocks included several HCVHCP CCGs.​

A 2017/18 baseline assessment of CCGs by RightCare showed Humber Coast and Vale to have the lowest adherence to NICE Low Back Pain and Sciatica Guidelines across the North of England. ​

Action

Our Improvement Unit supported the HCVHCP team to improve outcomes for patients by using the NHS Elective Care 100-day challenge transformation programme.​

We: ​

• provided coaching and facilitation support during the development and delivery of the project, bringing leaders and frontline staff together to test ideas​
• supported the production and implementation of a plan to ensure improvements were sustained​
• evaluated the project, including impact analysis and production of a final report.​

Sub-projects were formed around the following interlinked interventions designed to consistently implement the National Back and Radicular Back Pain Pathway and to reduce referrals to MRI:​

• Referral guidance for lumbar spinal MRI​
• Patient education​
• Clinical information campaigns.​

A survey of all GPs across the patch was undertaken. A set of key messages to underpin an approach to patient information was developed with broad input from clinicians and patient self-help groups.​

Impact

Physio First referrals increased threefold in pilot practices, leading to fewer referrals to secondary care.​

A new MRI referral form was devised along with a guidance postcard, including when to refer for MRI, for GPs to use in their consulting rooms. Patient information has been developed using the agreed key messages to achieve consistency and to de-medicalise back pain. A clinical training session and an education pack are being developed, informed by results from the GP survey.​

All three interventions tested in targeted areas are planned for roll-out across Humber Coast and Vale. Baseline data is being monitored to assess the project’s impact.​

A (100-day challenge) sustainability workshop shared the work and learning, secured commitment to complete and roll out projects, considered use of the methodology in other transformation areas, and determined next steps towards implementing the national pathway.​

The project provided a common opportunity for change, with a goal that was supported by all 28 organisations making up HCVHCP.​

Further information

If you would like more information about our services, you can contact us on mlcsu.improvement@nhs.net