Helping people with painful bone and joint conditions see the right person

Musculoskeletal (MSK) conditions account for 30 per cent of GP consultations in England. Low back and neck pain are the greatest cause of years lost to disability in the UK, with chronic joint pain or osteoarthritis affecting more than 8.75 million people in the UK.

The Elective Care Transformation Programme developed a specification for MSK clinical triage services. These provide specialist clinical review of GP referrals for MSK conditions. They can involve a review of the referral or a face-to-face appointment with the patient in a community setting. This review by an MSK specialist ensures that patients are seen in the most appropriate setting across the primary, secondary and voluntary sectors.

Our audit found that MSK triage services reduce demand for secondary care services by 10 per cent.

This means that those patients who need to be seen by a hospital consultant are seen as quickly as possible, and those who don’t are saved an unnecessary hospital visit.

We also developed an MSK handbook which outlines ‘how-to’ solutions for local systems to improve the elective care they offer for people with MSK conditions.

First Contact Practitioner

The Elective Care Transformation Programme supported pilots in 41 areas, including Nottingham, West Cheshire and Gloucestershire, of First Contact Practitioners: physiotherapists with enhanced skills, often based in GP practices.

Patients with back and joint pain, including conditions such as arthritis, can contact the physio direct, rather than waiting to see a GP or getting a referral to hospital.

Findings from more than 6,800 FCP appointments at initial pilot sites showed that patients attending an FCP clinic instead of visiting a GP were:

  • significantly more likely to be offered expert advice and guidance: 69% received advice on self-care or exercise
  • less likely to have blood tests or drug prescriptions
  • less likely to be referred to consultant led services: services running for two or more months saw up to 21 per cent fewer referrals to hospital orthopaedic services.

In addition, patient confidence and satisfaction was very high: 99 per cent of patients had complete confidence in FCPs’ competence and 97 per cent were likely or very likely to recommend them to friends or family.

As well as improving care for patients, this reduced pressure on GP workloads.

We developed a national mobilisation plan for local systems to roll out this service for patients across the country as part of the NHS Long Term Plan. The whole NHS England patient population will have direct access to MSK First Contact Practitioners by 2023/24, across all Primary Care Networks.

Support tools include a specification for First Contact Practitioner services, setting out the key enablers and actions for each Sustainability and Transformation Partnership (STP).

The Elective Care Community of Practice is for everyone working to transform elective care. Find out more.