This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.


NHS England has launched a new programme with the aim of sustaining the delivery of evidence-informed, personalised, high-quality integrated healthcare of value to all. This new initiative, part of the Pathways for Better Health Programme, significantly increases the resource to support MSK service delivery.

The programme covers the breadth of MSK including orthopaedics, rheumatology and pain, spanning primary secondary and community services. You can watch the launch event here.

The programme has ten workstreams, each led by a relevant clinical specialist:

  • Diagnostics
  • Orthopaedics
  • Rheumatology
  • Primary and Community MSK Provision
  • Spinal Services
  • Falls, Fragility Fractures and Osteoporosis
  • Data, Validation and Coding
  • Communications and Developing MSK Networks
  • Supporting those with Long Term MSK Conditions
  • Outpatients

There is the intention to ensure that the programme is coproduced involving the range of stakeholders including people with lived experience and patient organisations. The aim is to support local system leads to deliver MSK services in line with the programme, rather than to mandate a specific service model.

BestMSKHealthThe primary and community workstream, led by Chris Mercer, will be vital to the success of the programme overall. The other workstreams all depend on effective support in primary and community services. Having all the pieces of work in one programme will enable co-ordination. At the launch event Chris talked about the potential for the new White Paper to start breaking down some of the boundaries in the NHS and the need for MSK leadership across all levels of the system.

Summing up, Andrew Bennett, National Clinical Director for MSK, encouraged everyone to engage with the programme as it develops. The work has only just begun. This will not be a top-down initiative. It will be based on collaboration and coproduction.

Look out for updates in future ARMA newsletters and on twitter using #BestMSKHealth.

Policy Paper

Integration and innovation: Working together to improve health and social care for all

Updated 11 February 2021

The Government published a white paper, “Integration and innovation: Working together to improve health and social care for all” on 11 February 2021. This sets out proposals for changes in legislation with the aim of enabling integration within the NHS in England and between the NHS, local government and other health system partners. The proposals are grouped under four themes: working together and supporting integration; stripping out needless bureaucracy; enhancing public confidence and accountability; and additional proposals to support social care, public health, and quality and safety.

Every part of England will be covered by a statutory integrated care system (ICS). These will be made up of an ICS NHS Body and a separate ICS Health and Care Partnership, bringing together the NHS, local government and partners. The ICS NHS body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs.

The paper includes a triple aim:

  • better health and wellbeing for everyone
  • better quality of health services for all individuals
  • sustainable use of NHS resources

The proposals follow an earlier consultation on building integrated care systems in England. Many of the proposals are along similar lines to what the NHS has been saying are needed. The emphasis on integration and the focus on better health and wellbeing for everyone is also welcome. Legislation alone cannot deliver good integration and there is general recognition that building good relationships will be essential to make the new structure work.

There are also questions being raised about the lack of patient representation or focus on coproduction in the proposals, whether they will represent an unnecessary upheaval at a time when the NHS needs to focus on rebuilding services, and the fact that social care and the future of public health are not included but will need to be addressed if the reforms are to work.

The Kings Fund has published their response to the earlier consultation, the Nuffield Trust has identified five traps to avoid and National Voices responded from a patient perspective.




by Sue Brown, CEO ARMA

Here we are back in lockdown, with the NHS under even more pressure and MSK services severely impacted. COVID-19 response is still dominating the work of ARMA, although we are also progressing plans for other work in 2021. There are some different issues for MSK this time around, and vaccination currently dominates our work. When some people with MSK conditions are vaccinated, the timings of MSK treatment may need to be considered.

I am delighted that ARMA can host a document setting out the principles for these timing decisions. It’s a webpage, not a download, as we are keeping it regularly updated as evidence and advice changes. Keep referring back to our site to ensure you are using the most up-to-date information.

Many people have had appointments and treatment cancelled, both in hospital and in community services. It is important that people receive good communication in this situation, including some indication of what to do while they wait. These recently published resources around patient communication were designed for hospital treatment but I think equally applicable for community services. Everyone understands the need for the NHS to respond to the pandemic. But they are also waiting, in pain, and they need to know when the NHS will be able to see them again.

ARMA continues to bring our members together to share intelligence and information about the impact of the pandemic on people with MSK conditions. We continue to bring this information into the way NHS England, with MSK stakeholders, is responding to the crisis. We continue to bring together all the important resources for MSK in relation to the pandemic onto one page on our website. This collaboration has given people with MSK conditions a voice in the face of very challenging times. This collaboration is growing; most recently Physio First has decided to join us and become part of this powerful voice for MSK.

We will continue work in this way to support the response to the pandemic for as long as it is needed. I look forward to a time when we can focus this voice on the challenge of building excellent MSK services after COVID without the risk of another surge, another lockdown. A time when the collaboration between NHS England, ARMA and many other MSK stakeholders can be directed at improving MSK services. As Clare Jacklin of NRAS says in her excellent blog, (do read it), I don’t want to go back, I want to look forward.

I want us all to look forward together.

ARMA’s first ever online multi-disciplinary conference was a great end to a difficult year. We wanted to bring together the whole range of stakeholders from across MSK health, including policy makers and people living with MSK conditions to talk about how we can do things differently and work together.

Two thirds of those completing the feedback described the conference as excellent.

  • Happy to be there for a brilliant day! Well done to all – great discussions, speakers and openly discussing challenges & solutions.
  • Really thought provoking presentations.
  • What a fantastic conference with interesting topics and compelling presentations. We definitely enjoyed the virtual networking on our exhibition stand!

We wanted the conference to have an impact beyond the presence on the day. The feedback since then shows we achieved that. We’ve heard of new connections and collaborations arising directly form the conference. Delegates also had the opportunity to sign up for a post-conference virtual chat with another delegate and we’ve heard about some great conversations coming out of this too.

Post-conference feedback also gave us lots of ideas about how to improve if we do this online again, and what topics people would have liked to see covered, including social prescribing and public health. Interest in attending a future online conference was stronger than the interest in a face-to-face conference.

At the end of the day, one delegate tweeted:

  • #MSKTogether has finished with lots to think about. Great conference, look forward to more.

We’ll be thoroughly analysing the feedback before deciding what to do in 2021. Watch this space.

At 7pm on 21 September 2020, people living with musculoskeletal conditions and healthcare professionals and policy influencers congregated in anticipation of a tweet chat on Twitter – ‘Power to the People.’

The tweet chat encompassed co-production of a new NHS MSK strategy – patients and healthcare professionals improving care together. The discussion for that hour involved 51 people, 279 posts, 1197 engagements. The #MSKCoPro was seen over half a million times by over 100,000 users.

If you missed it, there were too many tweets to publish them all, but here are some of the themes that emerged in response to questions about:

Please feel free to continue the chat using #MSKCoPro.

What gets in the way

A number of practical issues were identified such as people thinking it takes too long and lots of meetings but no action. Some very interesting discussions about power and about professionals’ vulnerability.

What helps

Lots of themes came up including giving patients control of the agenda, showing the difference their input will make, listening to patients, raising awareness and demystifying coproduction, the importance of taking time to build relationships. A lot about the fact this requires culture change.

Practical examples of coproduction in action

Last month’s newsletter included a blog about how NHS England/Improvement is working in partnership with people with lived experience of MSK conditions to “co-produce” work on MSK services. In September, over fifty people joined our tweet chat on co-production. In the course of an hour, professionals and people with MSK conditions engaged in lively discussion and debate about what helps coproduction, what gets in the way and good examples in practice. A summary of the discussion has now been published.

Coproduction means that all involved feel engaged in a collaborative healthcare approach with a shared commitment to quality, where everyone is treated with respect and dignity and everyone feels that their needs matter. To attain this, it is essential that patients and members of the public are engaged in all aspects of MSK healthcare through a co-productive approach to planning, delivering and improving services.

It’s not always easy to do, but it is important if we are to deliver services which work for the people they are intended to support. To assist in understanding patients’ experience of services during the pandemic, the MSK Lived Experience Group has produced a report of key themes to help inform decisions about MSK services. We encourage you to use this if you are discussing restart of MSK services or how to manage in the event of a second wave.

All these resources can be found on the ARMA website.

The NHS Change Challenge used crowdsourcing to identify almost 200 initiatives introduced during lockdown which proved beneficial. The project is now working to write these up in more detail so that we can publish them back onto the site for further comments and discussion. Due to the overwhelming responses received, the focus initially is on writing up the highest-scoring ideas based on impact and feasibility within each challenge area. 

The first two ideas have been published on the site. Keep checking for further ideas which will be published over the next few weeks.

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. ​