Latest feedback from the sector on proposed changes to secondary care
We continue to engage with the sector to develop an improved service delivery model for secondary care services. As part of the detailed design process, in March we sent out our second survey to suppliers to test our thinking and gather your feedback on proposed changes to the way services are delivered.
The survey was sent to Clinical Services, Elective Surgery Service, High Tech Imaging and Integrated Care Pathways for Musculoskeletal injuries (ICPMSK) suppliers. We also held meetings with suppliers, professional bodies and the Musculoskeletal Secondary Care Clinical Advisory Group to discuss the changes in more detail and hear their feedback.
A key change we’re proposing is the development of a new Musculoskeletal Secondary Care Service, which will replace the current Clinical Services contract for kiritaki (clients) with musculoskeletal injuries. The new pathway would strengthen eligibility and referral processes to ensure only those who really need specialist care receive secondary care services.
Under the proposed design, referrals into secondary care for musculoskeletal injuries would be triaged by a Musculoskeletal Secondary Care Service supplier. This new triage function would determine eligibility, prioritise referrals, and direct kiritaki to the most appropriate pathway for assessment and treatment, including returning to primary care where appropriate.
What we’ve heard from you through our engagement
- Most feedback supports the new Musculoskeletal Secondary Care Service as a way to create a more coordinated pathway for secondary care services and improve outcomes for kiritaki.
- There’s support for a central triage function as long as it’s clinically governed, uses strong clinical information, and allows escalation to medical experts or specialists for complex cases.
- To triage referrals to secondary care effectively, we should consider clinical findings and red flags, diagnosis or diagnostic uncertainty, functional impact and deterioration risk, work status and risk of prolonged incapacity, previous treatment and response, and equity considerations.
- Strong consideration must be given to which professions will perform the triage, taking into account their clinical expertise, training, and ability to know when a referral is not due to an ACC-covered injury.
- There is a risk that the triage process is influenced by conflicts of interest. Triage decisions must be based on clear clinical criteria and auditable with full transparency.
- There must be strong governance and clear limits to ensure triage does not lead to the over-use of imaging.
- The timeliness of triage decisions will be important to ensure acute cases aren’t delayed.
As we continue with the detailed design, we’ll keep the sector updated on what we’re learning.
This work is the next step in our efforts to strengthen how we commission secondary care services to support better recovery outcomes for injured people and a sustainable Accident Compensation Scheme. It’s an important part of our Turnaround Plan.