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Musculoskeletal services in Ealing 2013: Care closer to home

Abstract Community musculoskeletal services in Ealing are organized with an integrated care approach, with most patients being managed in primary care and community settings, while, at the same time, providing clear and fast routes to secondary care. This is both clinically effective and cost-effective, reserving hospital referral for patients most likely to need surgery. Ealing Clinical Commissioning Group (CCG) implemented a ‘See and Treat’ interface clinic model to improve surgical conversion rates, reduce unnecessary hospital referrals, and provide community treatment more efficiently than a triage model. A high-profile general practitioner (GP) education programme enabled GPs to triage in their practices and manage patients without referral. The integrated care approach was implemented incrementally in three phases between 2005 and 2013, with a fourth phase planned for 2015. In Phase 3, only patients triaged by GPs to hospital outpatients are triaged by a referral management service, serviced by senior clinicians from the community musculoskeletal service. This secondary triage accounts for 15% of total GP referrals. The remainder being booked directly with no further triage beyond the initial GP triage unless marked ‘urgent’.