Allied Health Professional Musculoskeletal Pathway Minimum Standards: A Framework for Action 2015-2016

5. Routine Allied Health Professional Service Provision

5.1 Standard F - NHS Board Working to Current National Waiting Time Targets

The National Delivery Plan for Allied Health Professionals (AHPs)^[105] defines the future vision for AHPs and the services they deliver. In doing this, it focuses specifically on a number of high-level outcomes that AHP services will effect, with key actions defined^[105]. Given the significant variation in musculoskeletal waiting times across Scotland^[105] NHS Boards will deliver a maximum waiting time of no more than 4 weeks for AHP musculoskeletal treatment^[105]. The Scottish Government will thereby work with NHS Boards on a 4 Week Rapid Access to AHP Musculoskeletal Services waiting time target^[47].

5.2 Standard G - Appropriate Use of Different Modes of Clinical Consultations

For a number of patients, access to AHP services will continue to include referral from a GP and a face-to-face clinical consultation with an AHP. The NHS in Scotland, similar to the rest of the UK is being challenged to provide high quality, safe and timely access to the right services with greater efficiency and improved productivity. It has never been so important and timely to establish appropriately responsive and acceptable clinical and cost-effective modes of access for the benefit of patients, their carers, NHSScotland and the wider societal economy. Advances in technology continue to provide real and feasible solutions to such challenges^[107]. Access to a range of AHP services need to be explored and NHS 24 (NHSScotland's Healthcare Confidential Helpline Service) is committed to exploit available technology in support of this and improving access to musculoskeletal services represents the first consideration in what is seen as a portfolio of service developments. Therefore telephony platforms and other Information Services (IT) resources may be used in the provision of clinical assessment and management of musculoskeletal conditions.

5.3 Standard H - Management Plan Discussed and Agreed as per Service Pathways

The European Pathway Association (2007)^[108] defines care pathways as "a complex intervention for the mutual decision making and organisation of predictable care for a well-defined group of patients during a well defined period". Characteristics of care pathways include:

• An explicit state of the goals and key elements of the case based on evidence, best practice and patient expectations;
• The facilitation of the communication, co-ordination of roles and sequencing the activities of the multi-disciplinary care team, patient and their relatives;
• The documentation, monitoring and evaluation of variances and outcomes and the identification of the appropriate resources;
• The aim of a care pathway is to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction and optimising the use of resources^[89].

When developing a pathway, one needs to take into account the evidence-based key interventions, the interdisciplinary team work, service user involvement, and the available resources^[109]. Care pathways are a concept to introduce person-centred care^[109]. Every patient is unique, but they should have enough in common to ensure care pathways are a useful norm, and patient and clinicians are able to make choices that differ from these pathways as needed^[110]. As Kravitz and Melnikow (2001; p585^)[112] commented "most patients want to see the road map, including alternative routes, even if they don't want to take over the wheel". Goal setting is considered key to person-centred care^[113] and thus integral to pathway management. Goal setting is specifically outlined in the Health and Care Professions Council (HCPC) Standards of Proficiency for all AHPs (2012)^{[114,115,116,117]} Table 3.

Table 3: Goal Setting Outlined in Allied Health Professions Standard of Proficiency Statements^{[114,115,116,117]}

Professional conduct means adhering to professional regulations^[118]. As such, the purposes of goal setting has been identified as to meet contractual, legislative and or professional requirements, and to either improve outcomes or evaluate them^[119].

A goal is an intended future state; this will usually involve a change from the current situation although, in some circumstances, maintenance of a current state in the face of expected deterioration might be a goal. Secondly, and of equal importance, a goal refers to the intended consequence of actions undertaken by the clinician(s)^[97].

NHS Boards should define and implement clearly defined pathways with agreed goals, with patients, for the most common musculoskeletal conditions. Pathways, however, do need to be developed locally, for adopting pathways without translating them and adapting them to specific organisations and teams could be unsafe and ineffective^[110].