Service Description and Care Pathways Sample Clauses

Service Description and Care Pathways. The Integrated MSK Service illustrated above ensures patients move seamlessly within the pathway as required. This allows patients to move between specialists within the MSK Service as clinically appropriate. For example, if a patient seeing a member of the Pain Management Team were thought to have a Rheumatological condition then that patient would seamlessly transfer over to a member of the Rheumatology team for further assessment. The use of Self-management must be promoted and delivered by the Service for patients through education and agreed supported self-management plans. Primary care clinicians should be supported to do what a ‘good GP should do’, resulting in patients being given appropriate information and management early in their journey. Primary Care interventions may include the provision of splints, joint injections in primary care by Commissioner’s agreement and up-skilling of GPs as clinically appropriate. The MSK Service will work closely with the front end of the pathway by providing support and advice. By providing educational, meaningful and regular feedback to referring clinicians, the quality of the referrals into the Service should continually improve. The feedback to Primary Care clinicians must include information about referral rates, and the quality of the referrals. In addition, generic training and education is delivered in accessible formats for all primary care clinicians. A variety of tools and techniques that can support patient information and increase their knowledge should be utilised to ensure that patients understand their conditions, what the treatment plan may be and that they are involved along the pathway of care. This is essential because with MSK conditions the recovery of the patient or maintenance of their condition is dependent on the actions of the patient e.g. undertaking specific exercises between appointments. Following a period of MSK treatment, a patient will be able to self-refer back via a telephone consultation initially (or any other appropriate method as agreed with the patient) with the Service if the same condition recurs within a six-month period. Self-management will be promoted and the importance of compliance with treatment regimens will be emphasised. The Service works towards a safe discharge after effective care where clinically appropriate. The exception will be certain MSK conditions, such as Rheumatological conditions, where on-going care provided by the MSK Service is clinically approp...