December 2014

CEO's Update

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Dear all,

And so another year has gone by, and a very successful year for ARMA it’s been.  Among other things, we have continued to expand our membership, delivered a ground-breaking international conference, gained increasing traction for our MSK clinical networks project in England, and produced a powerful  General Election Manifesto which Shadow Labour Health Minister Lord Hunt OBE, who was the keynote speaker at our annual lecture last week (on 10 Dec - Human Rights Day), endorsed point by point.

Our Manifesto will once again take centre stage from the very start of 2015, when we will be holding a Parliamentary reception sponsored by none other than the Chair of the Health Select Committee.

So, it’s been an emphatic year for ARMA and for the MSK community, and we have an exciting one ahead of us, full of promise for our Alliance. The profile of MSK has arguably never been higher, and this is down to the hard work of all of us and in no small part to our ability to combine our strengths and speak with one voice. When we pull in the same direction and work together effectively as an Alliance, we are a powerful force. And this coming year is probably our best opportunity yet to put this to good effect.

As this month’s newsletter is coming out earlier than usual, and no doubt many of you are preparing for the holiday season as you read this, this is a slightly shorter newsletter than usual, but what it lacks in number of entries it makes up for in quality - starting with this month’s guest blog, from our very own HSJ Top Innovator for 2014, Dr. Alan Nye. Warmest congratulations to him - it’s not often MSK gets this kind of attention, let alone recognition.

Finally, in recognition of the importance of Fracture Liaison Services, which is also one of the 5 priority areas identified by our MSK clinical networks project, we have also recently added the ARMA logo to the BOA’s Standards for Trauma (BOAST) document for the FLS.

Merry Christmas and a Happy New Year!

Guest Blog - Musings from Primary Care

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by Dr. Alan Nye, President Primary Care Rheumatology Society, Executive Director, Pennine MSK Partnership Ltd.

This is my final month as President of the Primary Care Rheumatology Society and it’s been a very interesting 2 years for me. I apologise that this blog is England-centric, but England is the totality of my NHS experience and I cannot write about areas outside of my experience. I would like to cover, albeit briefly, three areas that over the past few years have become very dear to my heart:

• MSK training for primary care

• MSK networks and commissioning MSK services

• Shared decision-making

 

For a long time the lack of training for front line GPs has been a real issue for the NHS. Yet action to address this on a national level remains painfully slow. This creates issues for patients such as delayed referral, for example in inflammatory arthritis, causing pain and avoidable disability, and this generates many unnecessary referrals for conditions that are better managed within primary care. As 20% of the GP workload is for MSK conditions, there is an urgent need for MSK to be a part of every GP trainee’s curriculum. However I do not hold any expectation that this will happen in the near future.

 

One solution would be to bring more specialists into primary care, particularly extended scope physiotherapists, who could provide a very cost-effective solution to growing MSK referrals. However, the current contracting and funding arrangements make this seemingly simple solution difficult to deliver. The NHS that has developed over the past 10 years is one of silos, with separate contracting and funding for primary, community and specialist care. MSK, like other long-term conditions, needs an integrated team approach. The Kings Fund in their report on out-of-hospital care has also highlighted this issue, and our MSK service in Oldham has also served as a model for others.

 

There are some glimmers of light on the horizon, however, with moves away from payment by results to a “year of care” tariff and different funding and provider models such as prime contractors; but there remains a “Berlin Wall” across many patient care pathways, with Primary Care being centrally commissioned with a variety of contracts (GMS, PMS or APMS) and community, mental and specialist care being delivered under standard NHS contracts and commissioned largely by CCGs. Where commissioners have re-tendered MSK services based on the prime contractor model we have developed in Oldham, transfer of financial risk rather than driving continual improvement in patient care is often the main priority. In our model in Oldham the financial risk still sits with the CCG and all savings from the programme budget are reinvested in patient care and are not taken as profit. This, in my opinion, has been one of the main factors in our success, and it’s an element that many others have failed to replicate. Whatever the provider model is, there has to be advantage in commissioning an entire care pathway and coordinating care to maximize the clinical outcomes, patient experience and financial spend. Also I feel many CCGs are just too small and lacking in specialist clinical knowledge to effectively and efficiently commission care, and the financial challenge faced by them is so great that they cannot invest in new care models unless they deliver savings within year.

 

One way of sharing and developing new models is ARMA’s MSK clinical Networks Project, which has the support of the NHS Confederation and is attracting a lot of interest from CCGs. Even though it is sadly under-resourced, this has to be the way forward, with local clinical communities working together with patient groups to deliver effective patient-centred care. Speaking at ARMA’s annual lecture last week, Lord Hunt said as much himself. The MSK Networks will take some years to develop and grow, and I hope central government and NHS England realise the need for some financial and management support. The responsibility for making the network project work lies with all of us, patient groups, professional bodies and clinicians.

 

Finally I would like to touch upon shared decision-making. Everyone now agrees that this is a “good thing” and three Cochrane reviews have highlighted the many benefits for patients, clinicians and the wider health service. It is now even part of the standard NHS contract. However there is also an assumption that “we do it already”, and yet looking at the scale of unwarranted variation in some care pathways, or the evidence from the National Patient Survey, indicates that we do not do it. The default position of many clinicians is one of unintentional paternalism, and there is a lack of recognition that to deliver effective shared decision-making we need to train clinicians and measure the outcome. Frustratingly, training staff and measurement is fairly easy to do and yet there is no general agreement on whose role or responsibility this is. Shared decision-making is yet another casualty of the Health and Social Care Act moving from having a centrally-commissioned programme to relative obscurity; it is much spoken about and referred to but seldom delivered in a systematic way.

 

So, in summary: I feel that on one hand we face tremendous challenges with the financial squeeze and a commissioning, contracting and payments system that act as a barrier to integrated care, while on the other we do have the answers to these problems ourselves. The MSK network project is a way we as an MSK community can work together to achieve cost effective and patient-centred care. To quote Peter Kay, the MSK NCD, “the elements identified in the ARMA project sit absolutely at the centre of the Five Year Forward View that the NHS and politicians have now signed up to,” and “there is now an excellent opportunity to drive this forward,” so we must all take ownership of it and make it happen.

 

Share and comment online.

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Members' News and
Resources

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BSR Chief Exec Comments on ABPI Report

BSR Chief Exec Comments
on ABPI Report

The British Society for Rheumatology's Chief Executive, Laura Guest, comments on ABPI's 'RAising the game: Translating national policy into local action for rheumatoid arthritis services.'

This new report finds worrying lack of local prioritisation of rheumatoid arthritis services, despite its impact on patients and the economy.

 

Early Birds for Annual Conference

The 'early bird' offer for the Rheumatology 2015 conference closes at the end of January.

This will be a world-class conference run by the BSR, the UK's biggest rheumatology conference for all health professionals with an interest in musculoskeletal conditions. Registration is open.

Click to read the ABPI report

NRAS Comments on the ABPI report

Commenting on the report, Ailsa Bosworth, Chief Executive of NRAS said:

“This is a heavy hitting report, which underlines the significant challenges to be addressed if we are to improve outcomes for all rheumatoid arthritis patients across England. In particular, to ensure the disease is properly prioritised at the local level, it is clear that the rheumatology community will need to work closely with local commissioners. Evidence from the audit of Joint Strategic Needs Assessments, produced by local authorities, makes for particularly grim reading and it is my sincere hope this report will act a catalyst to bring about change.”

Download the full report here.

Arthritis Research UK MusculoSkeletal Health Questionnaire

Arthritis Research UK MusculoSkeletal Health Questionnaire

Arthritis Research UK’s on-going partnership with NHS England to co-fund the piloting of a patient reported outcome measure (PROM) within the NHS has progressed into clinical testing. The name of the tool, which in its draft format was known as the M-PROM, has now changed to the ‘Arthritis Research UK MusculoSkeletal Health Questionnaire’, abbreviated as ‘MSK-HQ’.

As people with musculoskeletal conditions are treated at inpatient, outpatient and community settings, the work will seek to understand how the MSK-HQ can be used in these settings, by people with different musculoskeletal conditions, and the value brought by using it. This phase of the work will address clinical pathways for orthopaedic surgery, physiotherapy, and early inflammatory arthritis, and a fourth strand will look at the implementation of the MSK-HQ across a whole health economy as part of commissioning. The work on the second phase will continue to be led by the research teams at Oxford University and the Arthritis Research UK Primary Care Centre at Keele. For more information please contact Einan Snir, Health Data Analyst: e.snir@arthritisresearchuk.org

National Osteoporosis Society site

Fracture Liaison Service (FLS) Standards Consultation

The National Osteoporosis Society is leading an expert authoring group to develop the UK’s first Clinical Standards for Fracture Liaison Services in collaboration with the British Orthopaedic Association and British Geriatric Society.

These Clinical Standards are now out for consultation and they would be delighted to hear your views on them. The consultation document and response form are available on the Charity’s website at: www.nos.org.uk/professionals

They would appreciate responses to be sent to policy.issues@nos.org.uk by 12 January 2015.

An FLS Implementation Toolkit has also been developed along with accredited FLS Practitioner Training. Please see the attached PDF for further details including links to FLS resources.

Organisations are also invited to endorse the final version of the Clinical Standards. By endorsing the document and permitting the National Osteoporosis Society to add your organisation’s logo to the document, you can help raise standards of care across the UK.

If you are interested in this or you have any questions please contact Anne Thurston (a.thurston@nos.org.uk) or Ed Smith (e.smith@nos.org.uk).

New BACC Partnerships

New BACC Partnerships

New career videos from BAAB

The British Acupuncture Accreditation Board (BAAB) has produced some new videos highlighting the value of acupuncture as a career.

 

BAcC Partners NIHR

The National Institute of Health Research is to be a non-commercial partner of the British Acupuncture Council.

This means that BAcC grant recipients who are doing a project within the NHS will have access to NHS research support, essential training and priority for some of the various procedural hoops they have to jump through.

 

BAcC to be corporate member of RSM

The BAcC has agreed to be a corporate member of the Royal Society of Medicine.

The NASS 5-year strategy

The NASS 5-year strategy

The NASS Council of Management has now approved the 5-year strategy for NASS activities. Our plans are very much based on the surveys that were conducted in 2012 and 2013 of our members and people with AS.

In addition to our usual activities, such as:

• Running our helpline

• Supporting our 90 branches

• Providing information and support via the website and publications

• Working alongside the National Institute for Health and Care Excellence

• Supporting research

…NASS will also be focusing on:

• Early diagnosis

• Patient empowerment & self-management

• Access to physiotherapy & exercise

• Awareness

You can download a copy of the full strategy here.

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Spotlight On...

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NHS Alliance and RPS report on pharmacists

NHS Alliance and RPS report
on pharmacists

The NHS Alliance and the Royal Pharmaceutical Society have produced a new report on pharmacists and the role that they could play in general practice.

The report contains excerpts from a round table held with GPs, practice pharmacists and members of the public on 30 September this year, and explores the current role of pharmacists working within general practice, why this isn’t more widespread, what the barriers might be, and how they might be overcome.

Click here to read more.

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ARMA Calendar

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Edgar Stene Prize closes to entries                                                                           31 December 2014
Policy Leads meeting, 2-3:30pm, BOA, Lincoln’s Inn Fields                            13 January 2015
AS & You Roadshow event with NASS, Portsmouth                                           12 February 2015
BIMM Occupational Medicine, Exercise Prescription                                        21-23 Feb 2015
Policy Leads meeting – venue TBC                                                                         24 February 2015
RCN BSR joint rheumatology conference, Birmingham                                  24 - 25 February 2015
BIMM Module 5 – Ergomomics, The Upper Limb                                                28 Feb - 2 Mar 2015
Acupuncture Awareness Week                                                                                 2-8 March 2015
AS & You Roadshow event with NASS, Chester                                                   12 March 2015
ARRC International Acupuncture Research Symposium, London                  21 March 2015
Policy Leads meeting, 2-3:30pm, AR-UK, 41 Portland Place, London           24 March 2015
AS & You Roadshow event with NASS, Sunderland                                            23 April 2015
BIMM Diploma in Musculoskeletal Medicine – Part 1 Written                        01 May 2015
Policy Leads & Gold Stakeholders meeting, 2-4pm,
     Arthritis Research UK, 41 Portland Place, London                                        12 May 2015
BIMM Diploma in Musculoskeletal Medicine – Part 2 Clinical                       20 May 2015

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