Musculoskeletal conditions

Why is it important?

Musculoskeletal conditions affect the joints, bones and muscles, and also include rarer autoimmune diseases and back pain.

More years are lived with musculoskeletal disability than any other long term condition.

There are more than 200 musculoskeletal conditions which:

  • affect 1 in 4 of the adult population (many being young and of working age) which is around 9.6 million adults and 12,000 children in the UK  (Graham Stringer (2011), Hansard, col: 1342)
  • account for 30% of GP consultations, in England (Department of Health (2006), A Joint Responsibility: doing it differently, pp 16);
  • have an enormous impact on the quality of life of millions of people in the UK; 10.8 million days are lost as a consequence of musculoskeletal conditions (Graham Stringer (2011), Hansard, col: 1347)
  • are associated with a large number of co-morbidities, including diabetes, depression and obesity (Arthritis Research UK (2013), Musculoskeletal Health: a public health approach);
  • account for over 25% of all surgical interventions in the NHS, and this is set to rise significantly over the next ten years (Arthritis Research UK (2013, Musculoskeletal Health: a public health approach);
  • account for £4.76 billion of NHS spending each year (Department of Health (2011), Programme Budgeting Data 2009-10, June).

What is NHS England doing to improve care and outcomes for people living with musculoskeletal conditions?

NHS England has worked in partnership with the Arthritis and Musculoskeletal Alliance to support the development of the national musculoskeletal improvement plans including the development of strong, cohesive, care networks as a way of encouraging local improvements in care and patient outcomes.

Building and embedding local resilience and prevention opportunities supports the delivery of the Five Year Forward View. A person centred approach empowers patients to contribute to goals and care plans. A key outcome is to realise an individual’s potential for independent living, social participation, returning to work, and other meaningful activities to restore quality of life.

The programme aims to:

  • reduce inequalities and improve outcomes for patients with musculoskeletal conditions
  • develop ways to measure and evidence successful musculoskeletal services
  • define the skills needed to provide people with musculoskeletal conditions with the best outcomes
  • support a culture that shares knowledge, best practice and lessons learnt
  • drive the national prevention agenda including primary and secondary initiatives
  • embed a culture of prevention, self-management and resilience in line with the national agenda

In December 2016, NHS England, in partnership with the Department of Health, Public Health England and Arthritis Research UK published Providing physical activity interventions for people with musculoskeletal conditions. The report reviews the benefits of physical activity both for people with musculoskeletal conditions and wider society, and provides a framework that supports a tiered approach to intervention.

Musculoskeletal core capabilities framework for first point of contact practitioners

The Musculoskeletal (MSK) core capabilities framework for first point of contact practitioners has been published in partnership by NHS England, Skills for Health, Public Health England, Health Education England and the Arthritis and Musculoskeletal Alliance (ARMA).  It aims to ensure that people with MSK problems get rapid access to diagnosis and early management advice, being fully involved in their care through shared decision-making and self-management. It sets out a standard for consistent, safe and effective practice across a range of settings, including primary and community care, emergency care and occupational health services so that the range of healthcare professionals who work with patients with MSK problems can play a full role in helping to manage problems appropriately at the first point of contact.

Musculoskeletal Networks of Care project

Musculoskeletal Networks of Care is a partnership between NHS England and the Arthritis and Musculoskeletal Alliance (ARMA). The networks help to foster relationships between care sectors, and share innovative and best practice. They bring together all the musculoskeletal key stakeholders including professional organisations, the third sector, people with musculoskeletal conditions, and carers.

The networks project fosters relationships and supports a culture between local care sectors that shares best practice, lessons learnt and the dissemination of innovation that supports local system improvement.

Musculoskeletal Workforce Group

NHS England has established the Musculoskeletal Workforce Group with the Arthritis and Musculoskeletal Alliance, professional organisations, and Health Education England.  The group is working with stakeholders including clinicians, allied health professionals, managers, and patient groups to identify the core competencies required by clinicians who see patients with musculoskeletal problems as a first contact. The group are designing a competency framework. This is to ensure that people with musculoskeletal disorders receive the right care, in the right place, at the right time.

It is hoped that promotion of the competencies will encourage behaviour change in the current clinician workforce including primary care doctors, physiotherapists, and specialist nurses.  The competencies will also be embedded into future undergraduate and postgraduate curricula.

Musculoskeletal Indicators and Musculoskeletal Health Questionnaire (MSK-HQ)

To ensure we are continuously improving outcomes and experiences for people with musculoskeletal conditions, Arthritis Reasearch UK, Arthritis and Musculoskeletal Alliance and NHS England have published a recommended set of system level indicators, or metrics. For example, measures on the time taken to be referred to a hospital specialist, or whether you have had advice on muscle strengthening and aerobic exercise.

Commissioners and providers can use the indicators to determine the baseline quality outcomes and value of their service.  This will allow the identification of specific service areas to improve. The aim of the indicators is to maximise benefits to people with musculoskeletal conditions, improve quality of care and outcomes, and deliver the best value for money

Arthritis Research UK have also developed and published the MSK-HQ which is a short questionnaire that allows people with musculoskeletal conditions (such as arthritis or back pain) to report their symptoms and quality of life in a standardised way. The purpose of the work was to develop holistic indicators that reflect how well services improve quality of life for people with musculoskeletal conditions, such as arthritis or back pain. The MSK-HQ instrument is designed to be used across different musculoskeletal care pathways in different healthcare settings.

Delivery programmes

We are working with the support of our national musculoskeletal (MSK) networks and through the four regions to support a strong, cohesive, approach to MSK improvement including networks of care as a key enabler to drive forward local improvements in MSK care and patient outcomes. The approach will draw together a number of regional programmes such as NHS RightCare, Getting it Right First time (GIRFT), Prevention and Elective Care programmes that can provide ongoing support to the implementation of local system plans.

Find out more

If your organisation is involved in musculoskeletal projects or you would like to know more about the work of the national team, please contact england.clinicalpolicy@nhs.net.