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  • The Arthritis and Musculoskeletal Alliance (ARMA) is the umbrella body for the arthritis and musculoskeletal community in the UK, and our mission is to transform the quality of life of people with musculoskeletal conditions. We have 33 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Arthritis News

by Sue Brown, CEO ARMA

Happy New Year to all our readers. The start of the new year is a time to reflect on our successes in 2019 and to look forward to what can be done in 2020.

Some of my highlights from 2019 were the annual lecture on mental health and MSK, our roundtables on pain and on mental health and our webinars. The webinars have been very popular with thousands of people watching them live or in recording.

It was the final webinar in December that highlighted something about MSK health that we need to address in the coming year. The topic was care and support planning for MSK – it was an excellent practical session that I recommend to anyone who missed it. Year of Care and Versus Arthritis looked at how care and support planning (CSP) might be used for people with MSK conditions and found it was beneficial for both patients and healthcare professionals.

However, when a practice which had already implemented CSP for other conditions decided to offer it to people with MSK conditions they found that many of them had already been through the process as they also had other long-term conditions. Sadly, although CSP is supposed to include everything which is important to the person, MSK was not included in any of these plans. It seems that unless it is explicitly included, neither doctor nor patient will see an MSK condition as worth mentioning in the conversation. Yet again MSK health gets a lower priority than we at ARMA think it merits.

In December I attended a discussion about bone health by the Royal Osteoporosis Society. The closing words of the event were the need for people to understand that “bone health is as important as heart health.” That is so true, and not just in relation to osteoporosis. The ability to move, to remain socially engaged, to shop and prepare healthy food are essentials for long term health.

Every healthcare practitioner from whatever specialty needs to understand the importance of MSK and of pain to their patients’ ability to manage (and prevent) other long-term conditions. We will continue to press this point until it is inconceivable that a CSP conversation would not include a discussion of MSK pain and mobility. Until it is unthinkable for a local NHS body to plan for their population without thinking about their MSK health – MSK in the broadest sense, not just how to get hip and knee waiting times down (important though that is).

This vision will guide ARMA’s work in 2020. I know that you, the readers of this newsletter, are in a good position to help this. In 2019 I have met many people who have been inspired by ARMA’s work to do something – to ask their IAPT service to include IAPT-MSK Pain; to discuss MSK health with their social prescribing service; to look at introducing MSK into care and support planning; or to ask every person with an MSK condition about the impact on mood and quality of life. I hope that you will all resolve to join them and do one small thing in 2020.

Together we must say loud and clear: MSK health is as important as heart health.

HMSA Chair, Hannah Ensor, was at St Thomas’s Hospital in November, manning an HMSA stand to make contact with a number of staff and patients. Hannah spread the HMSA’s awareness and positive self-management approach, and as always, the message was well received and the HMSA gained several new professional followers as a result!

January #HypnOT event

In January HMSA has a new live event for members. #HypnOT is the brainchild of HMSA’s resident Occupational Therapist Jo Southall, and Kim Clayden, our Social Media Manager and a qualified Solution-Focused Psychotherapy & Clinical Hypnotherapist.

Starting on 6 Jan 2020 at 7pm, this member’s only course will cover the neuroscience behind anxiety, sleep, weight and pain management, and some practical tips and advice from Jo and Kim on managing these. As well as being healthcare professionals, they are also expert hEDS & PoTs patients. The sessions will run weekly from the 6 January through to the 3 February, all starting at 7pm and lasting roughly an hour. Each event will be streamed via the HMSA Members Only Facebook Group.

To be involved in the live stream and to have your questions answered live, you will need to be a member of the HMSA Charity. There are lots of other membership benefits which include two journals a year and enabling us to continue supporting the hypermobile community. For information on how to join the HMSA, simply click here for a standard membership or here for a family membership.

Study of Diagnosed prevalence EDS and Hypermobility Disorders in Wales

Last month saw the publication of a study looking at the NHS data held in Wales on patients with Ehlers Danlos syndrome or any of the conditions formerly known variously as Joint Hypermobility syndrome, Benign Joint Hypermobility, Hypermobility Syndrome Disorder, and so on. The study found that as a whole this group is far larger than previously estimated and that hypermobility related health issues are far from uncommon. The Ehlers-Danlos Society raised concerns almost immediately that the paper could be misinterpreted to mean that the rare types of EDS are not rare. The paper’s authors have recently responded to this criticism, you can read the original paper, the Ehlers-Danlos Society response, and the reply from Drs Demmler, Rheinhold, Atkinson, Choy and Lyons on the BMJ open website.

Guest blog by William Pett – Senior Policy Advisor, NHS Confederation

As people grow older, health conditions often become both more complex and chronic. Evidence shows that rates of those living with multimorbidity rise significantly with age; a recent study revealed that 30% of adults aged 45 to 64 years report at least two chronic conditions, increasing to 65% of adults aged 65 to 84 years and more than 80% for those above 85 years old.

For older people living with multimorbidity, musculoskeletal conditions are common. Organisations such as Versus Arthritis have drawn attention to this in recent years, highlighting that among those over 45 who report living with a major long-term condition, more than 3 out of 10 also have a musculoskeletal condition.

Yet, as those who have lived with comorbidities may tell you, the NHS has not historically dealt well with patients with multiple conditions. The health system has traditionally been focused around episodic care – one provider contracted to treat for one condition, another contracted to treat for a second condition. This in turn has made care pathways somewhat arduous for patients, requiring them to go to different locations for different conditions – especially problematic, of course, if you are older and less mobile.

Fortunately, things are beginning to change. The NHS Long Term Plan, which builds on the principles of the Five Year Forward View, looks to break down silo working across the health system and sets out how integration of services will improve outcomes for patients. There are likely to be several beneficiaries of more integrated working – including not just patients but also clinicians and the tax-payer – but it may well be those with multiple conditions who benefit most.

For those with musculoskeletal conditions specifically, care pathways are being made easier and more direct for patients through direct access to First Contact Practitioners (FCPs). Recognising that musculoskeletal conditions account for 30% of GP consultations in England, FCPs will allow those with conditions such as arthritis to see a physiotherapist at a local surgery straight away, without the need to go through a GP.

More broadly, the old model of GPs referring patients out to different specialist and community services is being streamlined through Primary Care Networks (PCNs). These will bring together GP practices and community services in neighbourhoods across England, with the aim of achieving fully integrated community-based health care. A key feature of PCNs will be multidisciplinary teams, comprising a range of staff from pharmacists to district nurses to physiotherapists, as well as those from the social care and voluntary sectors. Someone living with multimorbidity will therefore be able to have a single comprehensive care plan that recognises the complexity of living with multiple conditions at community level.

We are, however, in the very early stages of the new integrated world. Clinical directors leading PCNs are still settling into roles that didn’t exist a year ago, within networks that didn’t exist a year ago. There are multiple expectations being placed on PCNs and many clinical directors are beginning to feel overwhelmed. This is where the NHS Confederation comes in. The Confederation has launched NHS Primary Care, which will act as the voice of PCNs as they develop and begin to deliver against new service specifications. Crucially, if the ambitions of the Long Term Plan are to be achieved – and if care is to improve for those living with comorbidities – then it is vital that new integrated care models are given the time and resources they need to succeed.

Versus Arthritis would like to thank everyone who supported their aims during the election campaign:

  • Almost 2,000 people asked their candidates to pledge to champion the needs of people with arthritis;
  • 6,000 emails were sent to candidates across the four nations;
  • Hundreds of candidates tweeted and emailed their support.

People can still add their voice by sending a message to the MP in their constituency about what it’s like to live with arthritis and why they need to take action. Visit the General Election page on the VA website.

NICE is developing a guideline on Behaviour change: digital and mobile health interventions and ARMA has been invited to register as a stakeholder.

If your organisation would like to register as a stakeholder for this guideline, please complete the online registration form which can be accessed via the topic webpage.

Organisations registered as stakeholders can comment on the draft scope and draft guideline, and contribute in other ways. Registered stakeholders will have the opportunity to comment on the draft guideline during consultation and all comments received from registered stakeholders will be considered and responded to individually. You will also be privy to an embargoed release of the guideline prior to publication in the public domain.

For more details, see Developing NICE guidelines: how to get involved.

 

You may have noticed that the PCR Society is now PCRMM – Primary Care Rheumatology & Musculoskeletal Medicine Society. The Society feels that this new name encompasses all of the conditions covered and will encourage more GPs, physios and AHPs to both join the Society and attend the conferences.

The PCRMM is pleased to welcome Lucy Douglas as the new President of the PCRMM. Elected at the recent AGM, she is a GP with a special interest in MSK, primary care rheumatology, and MSK ultrasound, currently working in East Lancashire and West Yorkshire. She has been a PCRMM member for some years. 

“I follow in the footsteps of some great and inspirational predecessors and I will endeavour to continue their good work. I believe primary care is the cornerstone of good, equitable, cost effective, holistic, and efficient health care.  Musculoskeletal problems will affect all of us at some point in our lives, and it’s therefore vitally important that primary health care providers have the expertise and resources to diagnose and manage such conditions.  As President, I would encourage all those health care providers passionate about helping everyone, young and old, to optimise their musculoskeletal health, in order to lead more fulfilling and productive lives, to join our friendly and progressive society.”

The next conference is scheduled to be held 12-14 November 2020. More details will be available on the website www.pcrmm.org.uk shortly.

In early December the initial cohort of the multi-year service improvement programme Aspiring to Excellence met for their first day of shared learning. The cohort, made up of members of the six teams awarded a place on the programme, began the process of planning for their department’s improvement aims.

The group will meet four times a year for three years and be given expert support to help catalyse across-the-board improvements in the availability of services and quality of care available for axial SpA patients. NASS will be sharing the progress as the teams continue to meet.

The six teams awarded a place on the programme are:

  • Axial Spondyloarthritis Service team, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Sheffield Spondyloarthritis Team, Sheffield Teaching Hospitals NHS Trust
  • Axial Spondyloarthritis Service team, University Hospital Southampton NHS Foundation Trust
  • Axial Spondyloarthritis Service team, Royal Berkshire NHS Foundation Trust
  • The Leeds Spondyloarthritis Service, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust
  • Spinal team, Fife Rheumatic Diseases Unit, NHS Fife

One of the Aspiring to Excellence team members who attended on 3 December said: “All of this is new to me and seems like an excellent way of driving positive change.”

To read more about the programme and the teams involved, please visit the NASS website and for further information about the programme please contact annamcgilvray@nass.co.uk

Osteopaths can, and do, make a positive impact on the public’s health. We are focused on prevention and the maintenance of health and wellbeing – so it’s natural that we are considered part of a wider health workforce that can make every contact count.

Shirley Cramer, the CEO of Royal Society Public Health, shares her view of the role of osteopaths in social prescribing as the iO’s opening keynote speaker at iO Convention 2019. Watch the session here: