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.

Laura Finucane, our Clinical Director at Sussex MSK Partnership Central, is also President of The International Federation of Orthopaedic Manipulative Therapists (IFOMPT).

This year the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) – the world conference of musculoskeletal and manual physical therapy, celebrates its 50th year as a global leader in Orthopaedic Manual Physical Therapy (OMPT) excellence. The event welcomes experts from all over the world to its conference in Switzerland to explore:

1. Innovative models of care in musculoskeletal and manual physical therapy
2. Physical therapy futures – emerging areas
3. Expertise in musculoskeletal and manual physical therapy

“Sharing ideas and initiatives among colleagues and experts is crucial for developing excellence and helps pave the way for reducing musculoskeletal disorders globally – and enables people to bring new ideas into their local services.

 

This is my fourth and final year as president, and the 50th anniversary of IFOMPT, and I am excited about the discussion and debates and learning about the initiatives taking place around the world and turning those ideas into practice.” ~ Laura Finucane president of IFOMPT and Clinical Director for Sussex MSK Partnership.

Laura has been involved with IFOMPT for the last 18 years, serving on the executive committee for the last 12 years and president from 2020-2024.

Also attending from Sussex MSK Partnership Central are Andrew Kemp and Stephanie Hemmings.

Andrew is an Advanced Practitioner and Stephanie is a research and Audit Lead, Senior MSK Physiotherapist and Lecturer in Physiotherapy at University of Brighton.

They will be presenting a poster titled “Equity factors in trials of physiotherapy for meniscus tear: A systematic review”​  and Stephanie will also be presenting on our nationally celebrated Community Appointment Days (CADs).

The International Federation of Orthopaedic Manipulative Physical Therapists Incorporated represents groups of Manipulative and Manual Physical Therapists around the world who have completed stringent post-registration/post-graduation specialisation programmes in the field of neuro-musculoskeletal disorders.