1. Orthopaedic Referrals ViaMulti-Professional Triage Teams and Polyclinics Mr Benedict Rogers MA MSc MRCGP FRCS(orth) The Fred Heatley Meeting 27 Feb 2008, Brighton

2. The days of the district general hospital seeking to provide all services to a high enough standard are over. Sir Ara Darzi, Health Minister, The Guardian, 11 July 2007 3. Polyclinics - the next big thing? Nick Triggle ,BBC News, 7th Oct 2007

Department of Health. 2000; The NHS Plan: a plan for investment, a plan for reform

Department of Health. 2002; Improvement, expansion and reform - the next 3 years: priorities and planning framework 2003-2006

The NHS Plan 1 , formalised concept of extended roles

Primary care setting

• • • • - Reduce OPA load by 1 million by 2006 2

• - Improve quality of referrals

Musculoskeletal : GPwSI & physiotherapists

Multi-Professional Triage Teams or Polyclinics

4.

Policy rhetoric

MPTT and Polyclinics

No substantive evidence base

No published studies regarding

• • • • - Temporal delays

• • • • - Patient perception

• • • • - Diagnosis

5. Aim Evaluate consecutive referrals to a DGHlower limb orthopaedic clinic Direct from GP Via MPTT/Polyclinic 6. Methods 7.

9 month prospective study

Survey 277 consecutive patients reviewed in DGH lower limb orthopaedic clinic

• Demographics

• Time delays

• Patients perception of MPTT professional

• Diagnosis made, assessed by senior author

8. Comparative statistical analysis of the temporal differences between the two groups was performed using an ANOVA (SPSS 11.5) Patient Demographics Date GP Referred to MPTT clinic Date @ MPTT clinic Date @ Hospital Orthopaedic Clinic Reviewed @ MPTT by whom? GP/physio Patients perception of MPTT professionalconsultant/junior doctor/ GP/physio/nurse MPTTClinic Diagnosis None made/Correct/Incorrect? 9. Results 10. 277 PatientsReferred for lower limb orthopaedic opinion 132 patients Via MPTT clinic 145 patients Direct from GP 76 patients Seen by GPwSI 56 patients Seen by physiotherapist 277 new patient referrals Hospital orthopaedic clinic 11. MPTT patients wait 62.4 days longer (p