Hammersmith and Fulham (H&F) CCG is a small but densely populated borough with 180,000 residents living in 6.3 sq. miles.
The CCG is made up of 30 GP practices, responsible for planning and commissioning health services for the diverse population and significant health inequalities of the borough. Due to long waiting lists for Musculoskeletal (MSK) services, fragmented service delivery and a lack of innovation and pathway redesign, H&F CCG carried out a procurement exercise and commenced a new contract with Connect Health in May 2016 for:
- Community MSK physiotherapy services
- Outpatient orthopaedic services
- Outpatient rheumatology services
- Chronic MSK pain management services
The journey to tendering MSK services
H&F originally started a piece of work to look at community MSK alongside 5 inner North West boroughs – Central London, West London, H&F, Hounslow and Ealing.
There was a need to provide better health services out of hospital and more efficient use of limited resources but this was difficult to achieve and fragmented, delivered by a mixed provision comprising hospital based or hospital-run services in community clinics, community run services and some practice based services.
The tri-borough (H&F, Central London and West London) are all now working to the same MSK community service specification.
“We wanted to provide equitable provision across the whole patch so we widened the scope and included more pain and rheumatology in the scope of the redesign. As demand goes up and health care issues increase, you can’t keep on going forever with the same spec and contract without looking if it’s suitable for the population.”
Jess Simpson, Acting Head of Planned Care for CCG
For the first year of the service significant improvements have been made
Reductions in secondary care referrals by GPs year on year
- 14% reduction in Trauma & Orthopaedics
- 19% reduction in Rheumatology
Reduction in MRI expenditure
- 31% reduction Apr 15-Jan 16 compared with Apr 16-Jan 17
- 46% reduction in Jan 16 v Jan 17
Reduction in waiting times for MSK services, despite increase in activity
- 99% RTT (referral to treatment) rate
- 85% of patients are seen in physio clinic within 3 weeks from GP referral