Earlier this year we commissioned an evaluation of our Community Appointment Days.

Laura Finucane, Clinical Director at Sussex MSK Partnership Central shares her reflections on the evaluation.

Why was it important to have this evaluation?  

When we commissioned this evaluation, our main goal was to get an independent and fresh perspective on what we had already observed. We needed an objective review to validate our findings and to dig deeper into the data – helping us to see what might have been overlooked.

Most importantly, we wanted to assess it all through the lens of health inequality, ensuring our work is truly making an impact where it’s needed most.  

The value of independent scrutiny  

One of the key purposes of this evaluation was to keep evolving. We wanted the data not only to validate what we were doing, but to inform and improve future Community Appointment Days (CADs), strengthening the overall offer.

This has been an invaluable process, continually shaping how we support our community. 

What have we learned?

A significant shift we’ve made is moving our health hub to the front of the patient journey. This simple change led to a dramatic increase in screening for blood pressure and diabetes – a real success in terms of uptake. But the evaluation also revealed some gaps, like the fact that many people weren’t engaging with the information provided. So, we’ve now placed extra resources on stewarding, helping guide people right from the front door.  

Data has become a powerful tool for us, highlighting areas that need further attention and helping us plan the next steps. We’re seeing the importance of exploring longitudinal data to understand long-term outcomes. And one key takeaway? Both people attending and staff have really valued the service, with many staff members appreciating the chance to step outside their usual routine and connect more deeply with people and colleagues.  

Importantly, this evaluation has paved the way for new initiatives, particularly in tackling health inequalities. We’re now focusing on reaching those who don’t typically engage with services, ensuring that our approach is as inclusive as possible. 

Applying our findings to future work  

Looking ahead, we’re keen to build on what we’ve learned. Our current model was developed with patients on waiting lists in mind, but our future plans aim to offer CADs as the first touchpoint in a person’s health journey with us. We believe this early intervention will help people understand what to expect and get the support they need sooner.  

We’re also strengthening our collaboration with the voluntary and community sector, ensuring our offer truly reflects the needs of our local population – and we’re using data to guide us every step of the way. 

Laura’s reflections on the project  

This project started with a bold vision in 2022, alongside Natalie Blunt, Managing Director of Sussex MSK Partnership Central.

We took a risk in trying something different, but with the focus on what matters most to people who access the service– staff thought we were a bit mad at first – but gradually, they came on board. Initially, there was a temptation to simply ‘lift and shift’ hospital services to the community, but we knew that wasn’t the right approach.

What we needed was a more radical change, and our staff fully embraced that challenge. 

The CAD continues to evolve, change and works because of the enthusiasm and dedication of the team. This has only been possible because of that commitment and the team effort. 

It was the culture of the organisation that allowed us to take those risks and pushed us to think outside the box. We were supported every step of the way.

For me, one of the biggest takeaways has been the sheer joy of working with our staff in such an engaging and inspiring way.

This journey has been full of learning, growth, and joy, and it’s something we’re all proud of.

You can read the Evaluation Summary or download the full Review and Evaluation document here.

We’re delighted to publish the Sussex MSK Partnership Community Appointment Days Evidence Review & Evaluation, and share our learnings.

As a not-for-profit, we’re always focused on learning from our work and pushing to improve our services, ensuring exceptional care reaches everyone. This review highlights the tangible impact CADs are having on MSK care delivery and reveals key insights that will help us build on this progress. 

One of the standout successes of the initiative has been the rise in Patient-Initiated Follow-Up (PIFU) rates. More than 50% of CAD attendees opted for this approach, a significant increase compared to the 12% seen in other services. Although national evidence on PIFU’s effectiveness is still emerging, these figures suggest that CADs are making a real difference in promoting long-term self-management.

How are Community Appointment Days making a difference? 

• Supporting self-care: Over 50% of patients who attended CADs were able to move to self-care after just one session, reducing the need for ongoing clinic visits. 

• Boost in Patient-Initiated Follow-Up (PIFU): More than half of CAD attendees opted for PIFU, compared to just 12% in other services. This shows that patients are taking charge of their long-term care. 

• Overwhelmingly positive feedback: Patients and staff alike have praised the expert advice, personalised care, and collaborative environment that CADs offer. 

Helping to manage waiting times 

Although CADs weren’t specifically designed to reduce waiting times, we’ve seen another benefit: they’ve helped us keep waiting lists stable, a big achievement given national trends of increasing backlogs. 

Read evaluation in full 

We’re excited to share these findings with you. You can download the complete Evaluation Review and Report and dive into all the details. 

If you’re thinking of starting your own Community Appointment Days, check out our Essential Ingredients guide for tips on how to get started.  

Curious about how CADs work? Read more in our blog series:

• Community Appointment Days – An idea that rapidly turned into an innovation
• Community Appointment Days – What makes them tick
• What if we made community powered health, for everyone

Evaluation overview

Support for self-management: 

• CAD effectiveness: The initiative has significantly improved patient self-management, with over 50% discharged to self-care after just one CAD appointment. This suggests a reduction in the need for multiple follow-up appointments, potentially easing the burden on downstream clinics. 

• PIFU outcomes: CAD patients had a much higher rate (over 50%) of Patient Initiated Follow-Up (PIFU) as an outcome compared to other services (12%). Although the evidence base for PIFU’s effectiveness is limited, the higher rate in CAD indicates a positive impact on long-term self-management.

Patient experience: 

• Positive feedback: Patients reported overwhelmingly positive experiences, especially regarding face-to-face expert advice and personalised care. Despite some operational concerns like waiting times, patients felt involved and heard, meeting the initiative’s goal of enabling active participation in care.

Staff experience: 

• Professional development: Staff enjoyed the CAD events, appreciating the opportunity to spend quality time with patients, understand their needs, and provide tailored advice. The collaborative environment also fostered a sense of collegiality. However, there were some negative comments about operational issues, such as workflow and IT challenges. 

Adoption and attendance: 

• Good adoption: High conversion rates from invitations to attendance indicate strong adoption of CAD across different areas. However, attendance variations by age group suggest barriers for working-age adults, who may benefit from more advanced information and preparation. 

Exploration of broader health issues: 

• Broader services: Feedback indicates that CAD attendees could explore broader issues affecting their musculoskeletal (MSK) conditions giving people the opportunity to access support from other health and wellbeing services.

Impact on equity: 

• No perpetuation of inequalities: Analysis by age, gender, and deprivation suggests that the CAD initiative does not exacerbate inequalities. However, higher DNA (Did Not Attend) and cancellation rates among working-age adults indicate accessibility issues for this group. 

Waiting Times Impact:

Stable waiting times: The CAD initiative was not specifically designed to reduce waiting lists, but has shown a potential positive impact. From January to May 2024, the waiting list for Sussex MSK Partnership remained stable, while national trends show increasing volumes. Sussex MSK has also reduced the number of patients waiting over 18 weeks, outperforming the national average. Although a direct causal link between CAD and waiting list reductions cannot be confirmed, timing correlations and qualitative findings suggest a positive influence.

Potential long-term effect: Further analysis is required to determine CAD’s long-term impact on waiting times, but current patterns, combined with low Patient Initiated Follow-Up (PIFU) rates, indicate that CAD may contribute to sustained reductions if the initiative continues.

Limitations and recommendations: 

• Data and methodology limitations: The report is based on limited data from six CAD events without a comparator group. Longitudinal data and independent qualitative data collection are recommended for a more robust evaluation. 

• Key recommendations: 

• Commission independent qualitative data collection and follow-up with non-attendees. 

• Link CAD attendee data to primary and secondary care records to assess service utilisation. 

• Refine data on PIFU usage by CAD attendees, stratified by key demographics. 

• Maintain records of review and learning activities related to CAD and implement operational improvements. 

Background on MSK care: 

• Growing demand for MSK care: MSK conditions are a leading cause of disability in the UK, significantly impacting individuals and the healthcare system. The CAD initiative in Sussex aims to address these challenges by providing a comprehensive, integrated care model in a community setting. 

Conclusion: 

The CAD initiative has achieved its goals of improving patient self-management and staff engagement. There are opportunities for further operational improvements and more comprehensive data collection to enhance future evaluations.

PRosPer – Long Term Conditions eLearning course has just launched, featuring a case study highlighting the impact of Community Appointment Days.

Sophie Wickins, Clinical Project Manager at NHS South, Central and West (SCW) approached Georgi Daluiso-King, from Sussex MSK Partnership to contribute to the programme upon discovering Georgi’s exceptional work in Personalised Care and her involvement in Community Appointment Days (CADs).

SCW’s Cancer and Long Term Conditions Team have developed the new PRosPer (Prehabilitation, Rehabilitation and Personalised Care) for Long Term Conditions eLearning for Health module on behalf of NHS England.

This collaborative piece of work was developed using the clinical and service redesign skills from within the SCW team and front-line clinicians doing amazing work in the field.

The case study is included in the Strategic Level module, which follows on from the 2 earlier modules (Foundation and Intermediate).

The case study states:

Sussex MSK Partnership Central is a joint venture delivered by Here (a not-for-profit social enterprise) and Sussex Community NHS Foundation Trust. 

 

They have truly embraced the PRosPer principles for improving services for people with LTCs. They have addressed every element of the House of Care through the development of their services.

Combining these insights and in-depth understanding of transforming clinical services, the module aims to provide practical examples and opportunities for clinicians, clinical leads, commissioners and people with strategic decision-making powers in developing the knowledge required to deliver quality improvements in their services and influence system change.    

We are pleased to confirm that this session is now live on the NHS Learning hub:    

Session link: https://learninghub.nhs.uk/catalogue/PRosPer-long-term-conditions?nodeId=7616 

Programme/catalogue link: https://learninghub.nhs.uk/Catalogue/PRosPer-long-term-conditions 

Have an idea or a project you think we could work together on? We’d love to collaborate with you!

Get in touch at: collab@hereweare.org.uk

Last Monday, colleagues from Sussex MSK Partnership Central supported University Hospital Sussex to see 240 people at their own Community Appointment Day (CAD).

Held at the Sports Centre at University Of Sussex in Falmer, the CAD supported people from Brighton through strengths- based What Matters to You conversations, and tailored advice, guidance, and rehabilitation depending on their individual needs.

Community providers were also on hand to offer additional support and to connect people on a wider basis with their health and wellbeing. Including SCFT Living Well Programme, Freedom Leisure, Aging Well, MIND, Together Co Social Prescribing, Brighton and Hove City Council and Sussex Integrated Care Board.

The feedback from those who attended was hugely positive and it was great to support people in the community.

“It was so wonderful to be listened to. Everyone was so kind. Please thank everyone as I now understand more about my condition and can be proactive in my recovery.” – Feedback from attendee

Look out for further CAD updates over the coming months.

As a social enterprise our purpose is to create exceptional care, for everyone.

We are incredibly proud of the services we deliver, and sharing our learning is an important part of our culture.

Many businesses talk about growth, for us, we measure that in terms of impact, as well as delivery.

That’s why we were so excited about our New Local webinar this morning, talking about our Community Appointment Day innovations in Sussex.

Today over 270 people were on the call, with the wonderful Natalie Blunt and Laura Finucane talking about how they got the CAD up and running, and what impact it had.

Whilst we are still tracking our data, and learning what works, what I’m left with this morning is the incredible news that across the country, CADs are popping up like mushrooms.

What started as a ‘what if’ conversation in our teams, is becoming an accepted idea – fuelled by a desire to experiment, to try something different, knowing that doing what we’ve always done will not solve the problems we face.

Its not just in MSK, and its not about waiting lists. Creating new ways to deliver truly personalised care is an idea our systems are ready for. Common sense innovation, that anyone can read about and think – how might we do that around here?

As a social enterprise, this is what we are about. Business for good. We’re excited to connect with others who are exploring this idea. We’re happy to share, and importantly we’ll learn from how this idea develops in other places.

Creating exceptional care for everyone is going to take change on a new scale. Strength based, community powered health.

Whether you’re daunted, deliberating or determined to try, we’d love to be connected.

In April and May, across two days, 550 people from our physiotherapy routine waiting list came and joined us in their local community at our Community Appointment Days. 

Community Appointment Days (CADs) provide a comprehensive range of MSK services under one roof. Conveniently located in local leisure centres, CADs offer a range of resources tailored to the specific needs of the local population, providing same-day access to services including assessments, advice, health promotion, rehabilitation and community and voluntary sector support, all in a non-medicalised environment.    

Taking the opportunity to step out of business as usual to look at how we might shape the future MSK service, we knew that the premise for doing so was multifactorial. We recognised that the current system tended to lean into treating people with a single condition, putting people on a pathway that focussed on a biomedical model, and where it was perceived people are best managed in a hospital setting. We also acknowledged that clinicians were being faced with increasing complexity and intensity of clinical practice, and consequently, staff were feeling burnt out with low morale.  

MSK practitioners at a Community Appointment Day (CAD)

Inspired by New Local’s Community Powered NHS and Victor Montori’s ‘Why We Revolt’, the CAD innovation leans into the strength of the community to find the solution to support individuals, shifting away from a paternalistic mindset to a therapeutic alliance which recognises the expertise individuals bring is equal to the expertise that clinicians bring.

Find out what people had to say after attending a Community Appointment Day here.

Download the Community Appointment Day Essential Ingredients.

Download the Community Appointment Day Information Sheet.

About Sussex MSK Partnership Central

Sussex MSK Partnership Central is a joint venture between Here, & Sussex Community NHS Foundation Trust. This is a prime contracting model supporting musculoskeletal (MSK) health for a population of 650,000 covering physiotherapy, orthopaedics, rheumatology and chronic pain. The service operates across central Sussex; including Brighton & Hove, Horsham and mid Sussex and Crawley.

Website: www.sussexmskpartnershipcentral.co.uk

Interested in finding out more about the Community Appointment Days?

Email collab@hereweare.org.uk or use the form below.