Musculoskeletal conditions

Why is it important?

Musculoskeletal conditions affect the joints, bones and muscles, and also include rarer autoimmune diseases and back pain. 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);
  • More years are lived with musculoskeletal disability than any other long term condition;
  • 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 with the Arthritis and Musculoskeletal Alliance in partnership 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, return to work, and other meaningful activities to restore quality of .

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.

Musculoskeletal Networks of care Project

Musculoskeletal Networks of care are 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 programme fosters relationships and supports a culture between local care sectors that shares best practice, lessons learnt and the dissemination of innovation that support local system improvement. We are currently developing a number of musculoskeletal resources, including expert webinars, blogs, and presentations for commissioners, providers, clinicians and patient groups. These support development of local musculoskeletal improvement plans, available via our online digital platform.

Musculoskeletal Workforce Project

The availability of services and treatment options for these conditions is variable.  A clinician’s lack of knowledge or confidence in managing musculoskeletal conditions can lead to increased referrals to secondary care. People currently experience a lack of coordination between primary, secondary, and community care, which does not have the person at the centre of their care experience.

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 will then design a competency framework. This is to ensure that people with musculoskeletal disorders receive the right care, in the right place, at the right time.

Promotion of the competencies are hoped to 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 project

To ensure we are continuously improving outcomes and experiences for people with musculoskeletal conditions, NHS England are producing 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.

Embedding Prevention and Resilience

NHS England and the Arthritis and Musculoskeletal Alliance are collaborating with governmental departments and agencies to embed prevention strategies in routine care. This includes development of a tool kit for commissioners to support provision of physical activity services (expected November 2016) and a return to work programme that is looking to identify best practice musculoskeletal interventions through a health-led trials programme.

Delivery programmes

We are working with the support of our national 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 Right Care, 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.longtermconditions@nhs.net