CCG Perspective on Integrated
System Redesign
Tim O’Donovan
September 17th 2013
The existing MSK system
• MSK System Redesign: the redesign of services that diagnose and
treat bone, muscle, and tissue conditions and disorders, and
associated pain
(ICD-10 Chapter XIII, M00-99)
– Includes elective orthopaedics, rheumatology, physiotherapy,
podiatry and chronic pain
– Excludes trauma and non-elective activity
• MSK patient population approx. 45,000
• Over 25 different provider contracts
• Total budget circa £25 million
The challenge: the patients’ view
• Referred to the wrong service/clinician
– Frustrated by no direct referral from part to the system to
another: “ping ponged back to GP”
– Continual onward referral to different elements of care until
diagnosis is received
• Poor co-ordination of information and administration across the
• No integration with social care at assessment
• Long waits for and within outpatient clinics
• Difficult to get in contact with team post-op
BCCG MSK Strategic Vision
• The White Paper: Liberating the NHS, provides an
opportunity to move towards integrated systems of care
• BCCG response to the opportunity and challenges highlighted
– Encourage integration of services through a system contract with
aligned incentives, improving the co-ordination of patient care
– Commissioning for outcomes, better value and less waste, with
patients getting the right care in the right place, first time
– Empower clinical leadership to challenge and champion, and to
develop new ways of providing care across the pathway
• Single budget, prime contract for 5 years
• Four main types of care:
Patient support and empowerment
Support, education and advice for primary care
Community-based MSK service
Use of hospital facilities only when those facilities are
• Incentivised game-changing outcome measures
Prime Contractor
National Context
Prime Contracting
Alliance Contracting
Outcome Focus
System Approach
Members Involvement
• Approach your local CCG/s, overview and scrutiny,
opportunities, good ideas e.g. joint injections
• Opportunity to get involved through workshops, clinical
networks – Output is influencing specifications, KPIs,
outcome measures
• Check supply to health – advertising market engagement
workshops, procurements
• Are you linked in locally? Discussion with local colleagues
on provision, federation, consortia, stand alone practice

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