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.

Common sense innovation is one of our by-words at Here – we believe in innovation, and doing things differently – we also believe in simple ideas that have great impact.

Community Appointment Days (CADs) are a simple idea, built on a bedrock of partnership, personalised care and devolved decision making. With all eyes on the growing NHS waiting lists, anything that serves to get people quickly to the care they need is gathering attention.

But what makes them work? Could this happen anywhere?  

These are my reflections on the story so far:

Partnership is key

As a social enterprise, we’ve been working hand in hand with our Sussex Community Foundation Trust (SCFT) colleagues for over ten years. At the CAD you can tell. Everyone introduces themselves as MSK Partnership staff. One team, not several. Everyone pulling together.

We draw on the agility and creativity of a small social enterprise and join forces with the expertise and credibility of the NHS. A perfect example of the whole becoming more than the sum of its parts.

MSK practitioners at a Community Appointment Day (CAD)

Personalisation is the difference

As an organisation our calling card is exceptional care for everyone. We specialise in personalised care approaches to long term conditions. We constantly ask the question – is this care exceptional – both in terms of the standard of care, and our ability to make an exception to respond to a particular set of needs.

The MSK partnership has a mission too – putting patients at the centre of their healthcare journey. Why does this help? It means we focus only on understanding what really matters to someone, and this has been the beating heart of the CAD.

Making sure we understand, and quickly respond to the things that are going to make a difference, and not wasting any time offering or pursuing pathways that just don’t suit.

Devolved decision making

If you are going to really be person-centred, and allow for shared decision making with people, your clinical team will need the autonomy and independence to enact creative thinking every day. By baking in clear vision and values in every part of the system, you can trust teams to do what matters. 

As a clinician you know that so long as you are holding true to the values, you have a great deal you can offer. Good for managers, good to staff, good for people.

Simple rules let you work with complex problems – and when it comes to caring for people, each and everyone of us arrives with our own complexities to understand.  

A learning culture

You know the saying, ‘Culture eats strategy for breakfast?’ If we’d set out two years ago with a strategic plan to reduce our wait list, it’s unlikely we’d have come up with this. If we’d had board sign off from all our partners, this idea would still be sitting on a table waiting for final governance sign off or a pilot.

By creating a culture of working in teams to solve day to day problems together, guided by principle but supported by robust data and learning, we have teams who are unusually used to trying out new things.  This ability to quickly learn, try and fail, change tack means we are improving all the time.

The CAD days evolved from a clinical validation approach that wasn’t working well. Our approach to learning meant we identified the piece that was working – the what matters to you conversation – sowed the seed for a whole day focused around this one conversation.

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.

We were lucky enough to welcome some of the team from The Chartered Society of Physiotherapy at our most recent Community Appointment Day to experience what this innovative approach is all about!

Sara Hazzard (She/her), Senior Strategic Communications, Campaigns, Policy, Improvement and Marketing Leader at The CSP has shared her thoughts about the day in a fantastic article for the Health Service Journal – ‘How to radically reduce your MSK waiting list in two days’.

You can read it in full here: https://www.hsj.co.uk/comment/how-to-radically-reduce-your-msk-waiting-list-in-two-days/7035793.article

Thank you to Sara, Mindy Dalloway and Clare Aldridge from The CSP for joining us.

To learn more about CADs: Community Appointment Days – An idea that rapidly turned into an innovation

Email: collab@hereweare.org.uk

In Norman’s first blog piece he shared his story ‘From Patient to Partner’, 12 months on he shares the next the chapter about his new role as Lead Health Builder.

Sussex Musculoskeletal Partnership Central’s (SMSKPC) ethos of delivering innovative care is what initially attracted me to volunteering as a Patient Partner in the MSK service in 2015. I wanted others to experience that same life changing personalised care in their own lives.

I spent seven years volunteering in the role, working on service improvements to support people in managing their health needs. Last year I took on a more formal role as Lead Patient Partner.

Soon thereafter and in response to the NHS Long Term Plan, Patient Partners changed our title to Health Builders. We wanted people to see us as more than partners in existing models of care. We wanted to be involved in the drive towards building better health for all and in improvements in care for unwell people.  

We want to support people in their journey to better health. 

As Lead Health Builder, I support the organisation’s strategic development, governance and service improvements. Being in this position and recruiting others with MSK and wider health service experience, helps to ensure people’s lived experience is central to considerations and decisions of the leadership team and that this in turn permeates the culture of the organisation.

Through the work of the wider Health Builder group, we build links with communities, the voluntary sector as well as local and national government to focus on ‘what really matters’ to people. 

The NHS Long Term Plan published last year, with strong implications of putting people at the heart of managing their own healthcare. This significant national policy change has to put people in control of their own health care journey, in partnership with clinical staff, other professionals and health focused charities.  

The plan pledges to develop ‘fully integrated community-based health care’. A bold new order in which there is a greater focus on prevention of disease and promotion of good health, supported by traditional treatment which is both exciting and challenging.  

We recognise the impacts of poor MSK health on general health and wellbeing. 

With MSK disorders affecting up to 20 million people across the UK and accounting for the fourth largest NHS programme budget spend of £5 billion, in England alone, we know that they account for one of the biggest areas of workload of the health service. We also know that 40% of this workload is due to potentially treatable risk factors. Our mission is not simply about workload, but most importantly it’s about providing exceptional care for everyone. And we mean everyone. 

Through innovations in care and operational processes, such as Community Appointment Days, self-referral, self-booking and electronic post-clinic letters to people and their GP’s, SMSKP has been able to deliver services in ways that really matter to people. This has led to greater efficiency and therefore less cost whilst improving care. 

Community Appointment Days (CADs) are events where people referred to the service are met in a community setting, such as a leisure centre or community hall. They are provided with a booklet, or passport, into which they enter all the information they gather during the appointment. We put patient records in the hands of those using our service and we simply scan their document as they leave.   

The CAD starts with a conversation with a clinical person to identify what really matters and advice and care are provided, or they can move on to a more in-depth examination and discussion about their condition. Thereafter a range of community support groups, health charities and local and national government organisations are on hand to provide advice and direction. A CAD really is a one stop shop. 

Impacts of MSK pain and disability have significant negative effects on the quality of life of millions of people in the UK; 10.8 million working days are lost because of musculoskeletal conditions and they are associated with many comorbidities, including diabetes, depression, and obesity. MSK conditions are reported to affect 1 in 4 of the adult population in the UK and they account for over 20% of all presentations in primary care. 

My days are spent in building networks with people, communities and both local and national organisations to work collaboratively to bring about change in the way health services are delivered. Being involved in decision making at the highest level within the organisation, as a service user, I am uniquely placed to have person to person conversations with those who are changing the way the system operates.

Being in a room together is key to how things can improve. It enables real meaningful conversation, person-to-person, human, conversations that get acted on. That is why I do this work – because I know being a Health Builder makes a difference. But I can’t do this alone. We need more people to be involved in this exciting and potentially life changing work for our Sussex communities.  The new Major Conditions Strategy recognises MSK conditions along-side high blood pressure, cancer and other serious diseases. We want to ensure good MSK care works for our communities and that it is fit for the future. We are not alone. The NHS is changing, and we are at the forefront of this change. 

We have shown the impact that personalised care has on people and the system. The transformative experience this has on those receiving and delivering care when the conversation shifts from ‘what’s the matter with you’ to ‘what matters to you’.

If you’d like to join us on this journey, please do get in touch: norman.webster1@nhs.net