7. Evidence of Implementation
Audit and service evaluation are important factors in improving musculoskeletal service provision[28,148]. Some potential examples of implementation of the standards are outlined in Table 5.
Table 5: Evidence of Implementation - Examples
|Standard||Evidence of Implementation (Examples Only)|
|First Contact Considerations|
|A: Screen for Serious Pathology Indicators (Red Flags)|| |
Use of GP web-based electronic advice and guidance tools with serious pathology indicators agreed across all musculoskeletal services.
Audit of implementation of national pathways such as SIGN Guidelines.
Audit of urgent referrals to secondary care linked to GP Quality Outcomes Framework (QOF).
|B: Consistent Advice from all Contact Points Utilising NHS Inform Resources|| |
Evidence of dissemination of NHS Inform contact advice, use of NHS Inform posters and wallet cards for service users.
Dissemination of NHS Inform details on local Service User Information.
|C: Medication/Analgesia as Appropriate|| |
Dissemination and implementation of analgesic advice.
Review of prescribing practices.
|D: Appropriate Investigations||Audit of referrals to radiology and other diagnostic services.|
|E: Equal Opportunities to Access MSK Pathways via Self or Healthcare Professional Referral||Evidence of standardised and equitable access to AHP services.|
|Routine Allied Health Professional Service Provision|
|F: NHS Board Working to Current National Waiting Time Targets||Evidence of capacity and demand mapping across all AHP services with empirical evidence of waiting time progress.|
|G: Appropriate Use of Different Modes of Clinical Consultations|| |
Evidence of different modes of consultation, face to face, telephone and video consultations.
Standardised assessment procedures and advice, evidence through notes and record audits.
|H: Management Plan Discussed and Agreed as per Pathways||Agreed standardised musculoskeletal pathways in situ with audit evidence of implementation.|
|Potential Onward Referral Work Up|
|I: Clinical Supervision Framework with Case Review Policy||Supervision standard operating procedures in situ for all AHPs with documented evidence of peer reviews and outcomes.|
|J: MSK Service Access to Investigations as Appropriate||Agreed access to diagnostic services for AHPs, as appropriate, and audit of implementation.|
|K: Process for Onward Referral||Agreed pathways for referral from AHP services to secondary care services, where appropriate and evaluation of implementation and use.|
Email: Susan Malcolm