New project to tackle orthopaedic waiting list

A new study will explore the best ways to actively manage Canberra’s public orthopaedic waiting list as the system groans under overwhelming demand.

Professor Jennie Scarvell, Associate Dean of Research and Innovation at the University of Canberra’s Faculty of Health, has received a $206,000 grant from the HCF Research Foundation to develop an Advanced Musculoskeletal Clinic at the Canberra Hospital. Her collaborative team includes Executive Director of Allied Health Dr Jo Morris, academic GP Professor Kirsty Douglas and surgeons Dr Tom Ward and Professor Paul Smith. Canberra Hospital already employs advanced musculoskeletal physiotherapists to manage its orthopaedic waiting list, including screening and triaging patients. However, Professor Scarvell said the existing system was struggling to cope with increasing numbers of referrals. “We just have far too many referrals coming through,”

Professor Scarvell told Canberra Doctor. “GPs are aiming to do the best for their patients by putting them on the waiting list for knee replacements years before they will need them, because they know there’s a 3-4 year wait, but it means we have all these people successfully with diet and physiotherapy exercise. However, she stressed that for those who require a replacement, it should be done at the optimal time, when they still have movement in the joint. “The amount of movement a patient has going into surgery is a key determinant of how successful the surgery will be,” she said. on the list who have not exhausted all the non-surgical options.”

Under the existing screening process, physiotherapists refer many patients to the GLA:D physiotherapy programs run at Belconnen and Phillip. However, Professor Scarvell said many patients have barriers to accessing the programs or do not believe they will succeed. Furthermore, there is not capacity to review patients regularly enough to ensure that if a knee replacement is required it is given at the optimal time.

Professor Scarvell said only 10% of people with hip or knee osteoarthritis have a joint replacement – most manage

“We know what best practice is because it has been rolled out in other places in Australia and in Scandinavia – patients need screening at regular intervals, to make sure people are getting knee replacements when they need them,” Professor Scarvell said. Professor Scarvell and a team of medical and allied health providers are working with consumers to develop the new clinic, which is expected to be established in early 2023. The clinic will be the first point of contact for patients who have been referred to Canberra Hospital Orthopaedics for a knee replacement or with osteoarthritis of the knee. While the specifics are yet to be worked out, Professor Scarvell said one option was to establish regular screening for all patients on the waiting list. Another model was to establish a drop-in musculoskeletal clinic in the community.

HCF data shows there’s been a 64% increase in members admitted for total knee replacement surgery in the ACT over the past five years. While patients can wait 3-4 years on the official surgical waiting list, there is also a “hidden waiting list” of patients still awaiting an initial consult with a surgeon. AMA has been calling for this data to be routinely reported.

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Feedback wanted on GP training

As we transition to GP college-led training in February 2023, the AMA wants to hear from GP trainees, GP supervisors, and practices about how the transition is going, and any issues or concerns you may have, so we can continue our work in advocating for GP training. You can reach us at workforce@ama.com.au. Rest assured all communications will remain completely confidential, and while we cannot provide individual advice, your experiences will help shape our feedback to RACGP and ACRRM to ensure all GP trainees enjoy a fulfilling and safe training experience.