Improvements to MSK and gynaecology in limbo?

Further to our earlier story “Brent CCG U-turn ?” we are sorry to say that all CCG work with partners and patients on MSK (musculoskeletal) and gynaecology outpatients services seems to have disappeared without trace.

The BPV proposal that the CCG should call a roundtable of all interested parties has been rejected in an email of 11 June from Sarah German, Assistant Director for Acute and QIPP. You can read it below. BPV’s idea was to find a way forward after the CCG abandoned its competitive tendering exercise in March.

The CCG justified discontinuing their integrated multidisciplinary MSK procurement on the grounds  that it was likely that there might be insufficient patient referrals into the service for it to be sustainable. The CCG say they are now in touch with providers but our informal enquiries have found no evidence for this. This only goes to confirm our suspicion that the problem was that a new multi-disciplinary diagnostic and treatment service for MSK would have cost too much money when the original driver for launching the “Waves” of new outpatient clinics was to save 10-20% off existing budgets.

We have responded to Sarah German’s email asking the CCG to think again but there has been no response at the time of this posting.

Robin Sharp, BPV Interim Chair    7 August 2015


Brent CCG response by email of 15th June 2015 to Brent Patient Voice statement and proposal arising from the abandonment of the procurement process for Wave 2 of the Outpatients’ Community Clinics programme 

Good afternoon Robin,

Sarah Mansuralli has asked me to reply to you on the issue of BPV and Wave 2 and I have set out below our intended approach for Spinal, Gynae and MSK over the next few months.

To set the scene I can advise that we now have a planned care team working on a few specialities to examine and understand the pathways that we have, where appropriate to agree new pathways and ensure that patients see the right professional, in the right setting first time.

If I could correct you on one point in your e mail you reference “before a QIPP team goes into too much detail” – this is in fact a clinically led planned care team with Dr MC Patel as clinical lead, myself as senior responsible officer and Miro Zvoc as project lead. We are working closely and in total collaboration with clinicians and speciality leads particularly at our main providers – LNWHT and Imperial and of course with all of our GPs.

In addition to this we are also looking at pathways and schemes that have been developed, and most importantly, successfully implemented in other CCGs not just in London but across the country.

Although there are some QIPP savings attached to most of these schemes our aim is actually to streamline pathways and avoid patients being bounced round the system and the frustration of delays that can occur.


As you already know this is a Brent, Harrow and Hillingdon project and was originally set up to ensure that the pathways, particularly for the cohort of patients requiring secondary care intervention but recently we have agreed a slightly wider remit for the project group including the following steps:

  • Understanding the current pathways
  • Patient, GP and Public engagement
  • Research and provider engagement
  • Developing new/revised pathways
  • Producing a business case
  • Internal assurance

You will be aware that in Brent we have held an initial workshop with some patients to explore the current pathways for spinal and to examine their efficacy. One major outcome from this workshop (certainly that I was not expecting) is that of concerns and issues raised around the delivery and access and robustness of pathways around Physiotherapy – I think this makes clear the need for these type of workshops going forward.


Following the cessation of the procurement for MSK we are scrutinising the output from the patient groups and draft specification to see what is possible to take forward constructively during 2015/16. Delivery and access to physiotherapy again here is a major issue and we also plan to take this forward during 15/16. We have also had some dialogue with clinical colleagues across T&O to again agree pathways and deliver follow up appointments in ways that are most convenient to patients.


Here we are following a similar process by looking at what can be taken forward from the outline specification and how clinical outcomes for patients can be improved.

It goes without saying that of course we will continue to hold patient engagement events as appropriate but do I believe that we need to have something tangible and some options that are clinically endorsed so that we get the maximum output from these workshops and engagement events and do not build delays into the process.

I hope I have provided you with some assurance about the processes we plan to undertake and about the absolute necessity for engagement going forward. One particular point I have noted is the need for the CCG to give sufficient notice of these events to ensure that there is a wide spectrum of attendees.

My apologies if I have omitted anyone from the circulation list but I would ask you to forward on my behalf.

Kind Regards

Sarah G

Sarah German

Assistant Director – Acute & QIPP

Brent Clinical Commissioning Group

Wembley Centre for Health & Care

116 Chaplin Road


Middx HA0 4UZ

Tel: 0208 900 5395 (new telephone number)

Mobile: 07904 116935


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