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by Greta McLachlan, Fellow at the Strategic planning and development cell, NHS England and Improvement, part of the Change Challenge Collaborative.

The change challenge collaborative is a group of professionals who have come together to work across the MSK, orthopaedic and rheumatology specialties to try and capture beneficial changes that have occurred within the NHS during COVID- 19. The aim being to try and capture these changes and ideas to ensure that these innovations are not lost when the NHS comes out of its pandemic measures.

Healthcare provision and delivery has changed greatly during COVID-19. Some changes have been detrimental to patients but not all. In fact there has been a whole host of innovations and different ways of delivering care across the NHS that have occurred in several weeks rather than the usual NHS pace of years.

We asked the communities of MSK, rheumatology and orthopaedics to tell us about the changes they had seen or instigated on a platform called Crowdicity.

Crowdicity is an online platform that allows collaboration of ideas and engagement through comments and discussion around each post. It was the ideal platform for us as it had been previously been used by NHS Horizons, but allowed our project to reach far further than a few emails for feedback might do.

In total over the four weeks that the platform was open for submissions, we had over 180 change ideas posted to the website, over 400 users registered, over 800 comments and some 10,000 plus page views. Our hashtag #nhschangechallenge got over 3 million impressions on twitter.

Once all submissions were closed, each change idea was discussed for its impact and feasibility and was assigned ‘themes’ so that we could see what commonalities there were between change ideas. The discussion that took place around each change idea took a co-productive, collaborative approach. For example, the group that discussed the rheumatology change ideas was made up of two consultant rheumatologists, one consultant physiotherapist, a patient with lived experience of MSK, a chair and secretary. The impact and feasibility were based on the premise that whilst some change ideas might be great during a pandemic and for a short period of time, they may not be feasible on a national scale or with the long term picture in mind. The same for impact. We wanted to be able to identify changes that would have greatest impact across the NHS, not just changes that have helped a small niche of patients or clinicians.

Now comes the hard part of this journey. Taking these change ideas forward and trying to work out how to champion them to the wider communities. ARMA has been a great supporter of this work, and helped us get to this point and I know will help us continue to make this project such a unique one as we look to next stage of this collaborative process. ​

Alongside the pain and misery of the Covid-19 pandemic there have also been some beneficial side effects – quiet streets and skies, birdsong, less pollution. This is also true in the world of MSK. ARMA has been a champion for the NHS Change Challenge, a project to identify the new and innovative ways of working that have been rapidly developed across the NHS and to ensure beneficial changes are captured and locked in. I think it is no accident that NHS Improvement chose to pilot this in MSK. The way in which the MSK sector has come together to collaborate and lead the changes needed to respond to the crisis has been outstanding.

The Challenge now has over 100 initiatives posted in just two weeks. Everything from online pain management classes to improved data collection, from virtual MDT meetings to different ways to deliver medication and avoid the need for hospital visits. It’s fantastic to be championing this project, encouraging the widest range of professionals to submit ideas and ensuring patient views inform the decisions about how to take this forward.

We are beginning to see the lockdown ease and services planning how to restart some of what has been put on hold. It’s clear this is going to be a long, slow process. ARMA’s involvement in a lot of different pieces of work will continue. We’re pushing for better support for people shielding, including advice on return to school for children shielding. We’re enabling collaboration to support private MSK practitioners to make the right decisions about when and how to return to work. Many people with MSK conditions choose to see a private healthcare practitioner and their contribution will help ease the pressure faced by the NHS. We’re continuing to raise the many issues coming through to patient organisation helplines and to contribute to NHS MSK services response to the crisis.

We are also beginning to think about restarting some of our business as usual. Tickets for our conference, Working Together to change the face of MSK, are now on sale. I’m looking forward to discussions with some of the most innovative and forward thinking people in the world of MSK. So if you want to join us, book now while early bird rates apply. Whether we deliver it as planned, as a conventional conference, or online, it will be a fantastic day, no doubt informed by the NHS Change Challenge as well as some brilliant work that was happening before Covid-19.

We also continue to deliver our webinars during lockdown, with one in April and one this week, both with a paediatric theme. Thanks to those presenters who have given their time to enable this.

Like everyone else we will continue to balance responding to the crisis with delivering our existing plans. 2020 will not turn out quite as I expected. Thanks to the NHS Change Challenge, and some extraordinary collaboration, it will be a year of progress for MSK.

New information on preventing musculoskeletal #bone, joint and muscle pain, and supporting mental well-being, has been compiled by NHS England, The Chartered Society of Physiotherapy, Versus Arthritis, Public Health England and ARMA.

See the Managing your physical and mental health and wellbeing page on the CSP website.

Suggestions are rolling in for which changes the NHS has made during the pandemic that people think we should keep.

You can see the other suggestions and add or vote by visiting the NHS Change Challenge website.

Following a successful start for the first cohort, applications are now open for the Aspiring to Excellence programme in 2020. The programme is designed to encourage and recognise service improvement in axial SpA (AS) care and is a strategic partnership between NASS, BRITSpA and sponsoring companies AbbVie, Biogen, Novartis and UCB.

Whilst COVID19 is impacting on us all, NASS is keen to keep driving forward as much as possible and being practical with Aspiring to Excellence, and we welcome applications. The deadline for rheumatology teams to apply is 24 July 2020 and all the application details can be found on the NASS website.

For further information please contact


NASS is regularly updating their website with relevant COVID-19 information including how patients can assess their risk, medicines and biologic therapy, mental health and the effect of the virus on work and benefits.

Aspiring to Excellence programme 2020 open for applications

Following a successful start for the first cohort, applications are now open for the Aspiring to Excellence  programme in 2020. The programme is designed to encourage and recognise service improvement in axial SpA (AS) care and is a strategic partnership between NASS, BRITSpA and sponsoring companies AbbVie, Biogen, Novartis and UCB.

Whilst COVID19 is impacting on us all, NASS is keen to keep driving forward as much as is possible and practical with Aspiring to Excellence, and applications are welcome. The deadline for rheumatology teams to apply is 24 July 2020 and all the application details can be found on the NASS website. For further information please contact

ARMA roundtable on Pain

In October 2019 ARMA held a roundtable bringing together people working on chronic pain from a range of perspectives to discuss what might be done to improve the experience of people living with chronic pain. Around 10–14% of people (6 – 8 million) experience moderate to severely disabling pain. Currently services and support for these people are difficult to access. Whilst not all chronic pain is musculoskeletal, osteoarthritis and back pain are associated with over half of all chronic pain, so that the lack of support is a key issue for us. 

The report of the roundtable sets out the key points made during the discussion of the issues and possible solutions, case studies of good practice and recommendations for action.

Recommendations for local health economies

  • Changing commissioning, taking a strategic population health approach to ensure money is focused on the right things.
  • Developing community, place based, networked, biopsychosocial approaches to pain – a pain MDT without walls.
  • Social prescribing to provide support for self-management and peer support at scale.
  • A local group with representation similar to that at the round table to drive change in each area.
  • There are opportunities presented by the current direction in the NHS, such as the way commissioning is changing through Integrated Care Systems and Primary Care Networks. People working in or advocating for pain services locally should engage with this work.

Recommendations for national bodies

  • HCP education to include understanding and management of pain.
  • Education and reinforcement messages to emphasise the biopsychosocial approach.
  • Public education – including employers and public attitudes

See also: ARMA’s policy page on Pain and other posts tagged ‘chronic pain‘ on our website.

If you are referred for specialist non-urgent treatment, you currently should expect to be treated within a maximum waiting time of 18 weeks. Over the last year, the NHS has been reviewing this 18-week target. ARMA has been involved in the advisory group looking at this change.

The NHS England board meeting on 30 January announced plans to extend the testing period for proposed changes to the 18-week elective care measure into 2020/21.

This joint response was issued by National Voices, The Arthritis and Musculoskeletal Alliance, Versus Arthritis, the MS Society, the Neurological Alliance and Healthwatch England.

“We welcome NHS England’s decision today to give more time to its review of waiting times for elective care. It has been encouraging to see how NHS England’s review aimed to focus on improving people’s experiences, but in our mind, there were always questions over the timelines for looking at such a complex issue.

“The 18-week target covers a wide range of conditions with clinical outcomes and experiences affected differently by the length of time people wait. Issues such as good shared decision making, better information and ongoing support during waits also affect the experiences of people needing treatment. This is why we need more time to assess the impact of any changes to the target on people waiting for treatment.

“NHS England’s update today, is therefore, a very welcome move and shows that they are taking the feedback from patients and their organisations seriously. We look forward to continuing our work with NHS England to ensure the review comes to the right decision by 2021.”