Firstly, the opt-in referral method was implemented ahead of NHS England’s MSK recovery plan. This approach, used since late 2020, has significantly managed waiting lists post-COVID. The local system now includes forecasting predictions, reply rate analysis, and referral trends, enhancing overall efficiency.

For Havering MSK, the waiting time from referral to opt-in letter has been reduced from 10 weeks to 8 weeks, with majority of patients potentially receiving appointments within 3-6 weeks after opting in. 

Orthopaedic Services Improvement 

In February 2024, Mark and his team developed an extension of the opt-in waiting list management used for the Musculoskeletal Clinic Assessment and Triage Service (MACTS), as well as the Spinal and Musculoskeletal Assessment Service (SMAS). This initiative reduced wait times from 30-40 weeks to 5 weeks (SMAS) and 7.5 weeks (MCATS), within a 7 month period. The project included change ideas such as inbuilt reporting, conditional formatting, and data cleansing, streamlining the process and improving service delivery. The data in the chart below shows the actual waiting list during the past 12 months (Sep 23’ to Sep 24’): 

Email and Communication Efficiency: Mark created a single service email account and template emails to enhance productivity. Additionally, a contacts list of GP email addresses was built into Outlook, simplifying communication. 

Diary and Slot Management: Color-coded diary slots were introduced in RiO to prevent overbooking and maintain NP slots. This visual aid has helped clinicians and administrative staff manage appointments more effectively. 

Shared Drive Integration: Mark consolidated four service drives into one, removing duplicates and protecting patient information. This integration involved moving over 100,000 documents and streamlining folder structures. 

Digital Caseload Management: A digital RiO MSK caseload report was developed to help clinicians manage their caseloads efficiently. This replaced the previous paper-based system, making it easier to review caseloads during supervision or administration time. 

Excel-Based Injection Record: A new record was created for MCATS and SMAS services, replacing the paper record. This digital record is accessible to any staff member and includes drug and dosing drop-downs, making it easy to filter and search for administered batch doses. 

All these projects have been supported and assisted by both internal team members, and NELFT colleagues from IT, RiO and clinical systems without whom the improvements and efficiencies would not have happened. 

These initiatives have significantly improved efficiency, reduced waiting times, and enhanced overall service delivery in MSK and Ortho services. Mark has shown how little changes can result in big improvements, and in his words:

“I generally look for 5%’s to work on - these are the little things done repeatedly or the small things that can snowball with much bigger benefits to patients and staff. When you bring 5 small projects to fruition then a 25% improvement/efficiency can be seen.” 

Mark and his team are working on further improvement work around urgent referrals, reducing opt in letter time as well as utilising digital solutions for appointment management and we look forward to sharing further testing and data in the future.