Evidence of whole of system change has been provided again in Canterbury thanks to a joint effort to tackle the increased demand for orthopaedic surgeons.

With Canterbury having the largest population of older citizens in New Zealand, demand for the Canterbury District Health Board (CDHB) orthopaedics team is outstripping supply.

However, after the Canterbury Initiative worked with the team to create new pathways for shoulder care (known as the Shoulder Initiative), an increased number of referrals can now be accepted.

In fact, specialist referrals can now increase by 83% because more patients are being seen in the community.

As part of the initiative, the Canterbury Community HealthPathways team developed a new Shoulder Pain pathway* to help identify all the previously hidden non-clinical management options available in the community.

Clinical Editor Denise Nicholson says the aim of the pathway was to help GPs better manage shoulder conditions either when the patient first presented with pain or when the patient was returned to GP care.

“We included a video showing CDHB Orthopaedic Surgeon Mr Alex Malane demonstrating a basic examination of the shoulder to help determine the most likely cause of the pain. This lasts only about 90 seconds so GPs can have a quick look during a consultation,” she says.

“Of course, the pathway also includes details of how to manage the most likely condition. If conservative treatment fails, the GP can refer the patient for hospital assessment where the patient may be seen by an orthopaedic surgeon or a specialised shoulder physiotherapist. But they can also direct them into the Shoulder Physiotherapy Package of Care pilot for non-surgical treatment.”

The remarkable progress of the new orthopaedic triage of shoulder referrals was recently highlighted at a CDHB board meeting.

Measurements of referrals to physiotherapists for shoulder pain under the new system found that after initial assessment and treatment, 34% went on to have further investigations such as imaging while 38% continued with conservative management.

That left just 15% going on to have surgery, when before the initiative GPs were overwhelmingly referring patients directly to the surgical team.

After the success of the Shoulder Initiative, Canterbury Community HealthPathways will be working with the CDHB to define new referral pathways for lower back, hip and knee, foot and ankle, and hand and wrist conditions.

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*Access to the pathway is restricted to HP Community members.