With capacity and resource already stretched across the NHS, the financial and performance implications of this for NHS Trusts are significant. The NHS in England already spends £5 billion each year on MSK conditions, the fourth highest clinical spend.

Addressing this problem will require a coordinated and integrated approach. NHS guidance, including the Five Year Forward View and NHS Ten Year Plan, has emphasised the need to reduce inappropriate demand and move significant activity in the community, with MSK triage given as an example of where this could be realised effectively.

However, this will not happen overnight. Historically, there has been significant underinvestment in MSK services with finances more often focused on acute care. Progress has also been hampered by other challenges to the treatment and prevention of MSK conditions in England such as increasing demand, variation in the quality of care, and a disjointed and multi-provider landscape underpinned by perverse incentives.

We need to reverse the trend of medicalisation of minor problems and empower patients to self-manage the majority of MSK problems presenting to the system in primary care, urgent care and A&E. Locality services in “wellness spaces” such as leisure centres, helps to move mindsets and introduces some patients to better lifestyle choices.

At Connect Health we are determined to raise the quality and efficiency of MSK and community service provision working with partners across secondary and primary care.

We have a proven record of increasing access to MSK services, improving patient experience, and finding efficiency and savings within local systems.

Our work in Hammersmith and Fulham saw us, in collaboration with local commissioners and providers, redesign the MSK pathway, resulting in a number of substantial improvements. Notably by utilising Connect Health’s single point of access – Referral Management Centre and multidisciplinary team clinical assessment and treatment hubs we have been able to deliver:

o Reductions in secondary care referrals by GPs year on year
o Reductions in MRI expenditure
o Reductions in waiting times for MSK services, despite increases in activity

It is for this reason that we have partnered with the Good Governance Institute to produce national best practice guidance to help NHS commissioners and providers understand and optimise local MSK pathways.

Our new guidance will help NHS provider and commissioner board members understand the scale of the MSK problem nationally, and by including a series of key assurance questions and a maturity matrix equip them to self-assess the performance of their local service. Particular focus has been placed on ensuring that this document is a practical and useful tool for staff working across a range of organisations, and in a variety of roles.

To this end, it has been developed with input from a range of commissioners, clinicians and NHS board members and have been tested at a series of events in December 2018 and across February 2019.

Andrew Walton
Executive Chair
Connect Health


If you would be interested in hearing more about GGI’s Board Assurance Prompt or if you have any comments or feedback on the document’s content then please contact: marketing@connecthealth.co.uk

Please join us on 2 April 2019 as we launch this guidance. Visit the event page by clicking here for more information.

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