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

Commissioning

Since the NHS Long Term Plan (LTP) was published on 7 January 2019, the Universal Personalised Care: Implementing the Comprehensive Model has been published.

The document defines personalised care: people have choice and control over the way their care is planned and delivered based on ‘what matters’ to them and their individual strengths, needs and preferences.

There are six components to the model:

  1. Shared decision making
  2. Personalised care and support planning
  3. Enabling choice, including legal rights to choice
  4. Social prescribing and community-based support
  5. Supported self-management
  6. Personal health budgets and integrated personal budgets.

The document sets out the key principles of each component and what evidence would show that it is implemented.

Social prescribing – includes a reference to the need for this to be appropriately funded. There should be a one stop shop connector service with link workers (up to 5 per Primary Care Network) about to connect people to community groups and voluntary organisations that are supported to receive referrals. There should be community-based approaches to providing peer support. ARMA would argue that there is a role for patient groups in providing this peer support.

Supported self-management – This can include:

  • Health coaching or structured group coaching course
  • Self-management education approaches (face-to-face and virtual), which include disease-specific, generic and online self-management courses
  • Peer support through a link worker

Personal health budgets – People will have an indication of how much money they have available for healthcare and support, enough to meet the health and wellbeing needs and outcomes agreed in the personalised care and support plan. They will be able to use the money to meet their outcomes in ways and at times that make sense to them, as agreed in their personalised care and support plan.

 

Implementation

The document lists 21 actions needed to deliver personalised care at scale. These include:

  • Workforce training, including to all GPs.
  • An intensive face to face training programme for 75,000 health care professionals by 2023/4
  • Recruit and train over 1,000 social prescribing link workers by 2020/21
  • Work with partners in the voluntary and community sector, and others, to explore the best models for commissioning the local voluntary and community sector to support innovative provision.
  • Support for programmes to enable self-management
  • Train up to 500 people with lived experience to become system leaders by 2023/24.

For more details, see the full universal personalised care document.

 

As I sat down to write this, NHS Chief Executive Simon Stevens was on the radio talking about plans to increase the ability of patients to see pharmacists and physios rather than a GP as their first point of contact in the NHS. Ensuring we have the right workforce to meet the growing health needs of an ageing population is a real challenge. ARMA’s different professional members have a lot to contribute, as I discovered when I spent a day at the Royal College of Chiropractors conference.

Not all speakers at the conference were chiropractors. A rheumatologist spoke about the way chiropractors are often important partners in patient’s pathways for both diagnosis and management. A bold statement from another speaker, a physiotherapist: “chiropractors can help to save the NHS”. The chiropractors speaking all focused on how to improve practice, to increase skills in psychological and social aspects of health, taking a public health approach and making every contact count. It was the non-chiropractor speakers who challenged the delegates to step up to a leadership role. Based on my conversations in the breaks, I think there were plenty of delegates ready to rise to that challenge.

As CEO of an alliance, this is the sort of thing I love. Not professional rivalry (which I see too often) but professional collaboration. Yes, take a pride in your own skills and training, but do so with an understanding of what you have to offer to a multidisciplinary team. As the musculoskeletal patient population gets older, more complex and more likely to have other co-existing long-term conditions, no profession can act alone. The best surgeon can’t get good patient outcomes if rehabilitation is poor. The best rheumatologist can do nothing for the patient who wasn’t referred because no-one recognised the severity of their condition. Health is a system, not isolated episodes of care.

ARMA members include a whole range of professions who could contribute to the musculoskeletal health of the nation. The NHS Long-term plan presents us all with an opportunity. Benjamin Ellis of Versus Arthritis, another rheumatologist speaker at the conference said: “If the MSK community doesn’t get on the bandwagon, it will go without us.” We need to get on that bandwagon, with pride in what we can all offer, together as a community. That’s exactly what ARMA is here to facilitate.

The draft scope for this NICE guideline is now out for consultation; it is a valuable opportunity to ensure that the guideline considers issues important to your members. The consultation page contains the documents, background papers and instructions on how to comment.

The consultation on this draft scope will close at 5pm on 15 February 2019.

NICE will also be recruiting people with a practitioner, care provider or commissioner background and lay members (people using services, family members and carers, and members of the public and community or voluntary sector) to join the Committee for this guideline.

You will be able to find more information on these positions at the Committee recruitment page.

How to implement the National Back and Radicular Pain Pathway (NBRPP)

12.30 – 1.30pm Friday 8 March 2019

The webinar aims to support the implementation of the National Back and Radicular Pain Pathway. It will initially explain the pathway and present data from early implementers to help make the case for change in your local area. The physiotherapist who led the implementation of the NBRPP across Cheshire and Merseyside as part of the Walton Centre Vanguard Project will talk about her experiences, common barriers to implementation and strategies to overcome them.

Back pain is the largest single cause of disability in the UK, with lower back pain alone accounting for 11% of the total disability of the UK population as well as the largest cause of sickness absence.

The NBRPP is the product of a unanimous consensus of 29 stakeholders based on best evidence. Its objectives are to provide a streamlined care pathway for radicular pain and an effective, managed pathway for patients with low back pain. Value impact analysis has indicated substantial cost savings in early implementation in the North East. The Pathway is demonstrating improved clinical results in patient clinical outcomes and patient satisfaction.

Who should attend: All professionals involved in the commissioning and delivery of spinal care.

Register in advance for this webinar:
https://zoom.us/webinar/register/WN_pmMKfZ-LSE-Bi0KvA65EPQ

Presenters:
Stephen Hodges, NHS RightCare
Samantha Davies, The Walton Centre

Sign up for the webinar rescheduled for 15 February 2019 at 12.30—1.30pm

The rescheduled webinar on Friday 15 February 2019 describes the set-up of the Telford Musculoskeletal Service and some of the problems encountered along the way, with the solutions used.

The Service is a single-point of access for rheumatology, pain, physiotherapy, orthopaedics and musculoskeletal services in the NHS within Telford. The service is a prime vendor type model with Shropshire Community Trust holding the main contract and sub-contracting to other NHS and Private providers in the locality.

The speaker is GP Dr Louise Warburton and medical lead for Telford MSK service, which sees a wide variety of patients with MSK and rheumatology problems. She has wide experience in a variety of roles related to MSK services including GP champion for Keele University working in Primary Care MSK research and dissemination. 

Who should attend? Commissioners, first contact practitioners, GPs, hospital consultants, physiotherapists, patients and patient organisations and charities.

The webinar is provided by ARMA and NHS England. Previous registrants do not need to register again.

ARMA webinars are free to access thanks to the support of our partners. We would like to thank Roche Products Limited and Chugai Pharma UK for supporting this webinar.

You can now see the video from our recent webinar in the Musculoskeletal Networks series:
Commissioning for Quality: Community-based Rheumatology Service

Presented by Erica Gould, Nurse Consultant at Community Rheumatology Service Modality Partnership, the webinar outlines how a community-based rheumatology service can provide effective management of rheumatology patients, with benefits both to the patients and the usage of clinical resources.

Findings from the pilot study demonstrated that patients requiring disease-modifying anti-rheumatic drugs (DMARDS) can easily be managed in a community setting. A community setting with provision of the specialist skills provides patients with local, more convenient care and reduced disengagement. It also optimised the use of local resources – for example, moving some of the routine follow-up activity for rheumatology patients (such as drug monitoring) would undercut the tariff by 30%.

Visit the ARMA Webinars page to watch the presentation and discussion.

 

As you are hopefully already aware, a clinically-led programme called London Choosing Wisely is underway to develop pan-London policies for eight treatment areas, to ensure patients across London have consistent access to treatment that improves their health, based on the latest available evidence.  Full details about the programme, including a list of Frequently Asked Questions, are available online via: healthylondon.org/london-choosing-wisely

The London Choosing Wisely programme expert groups for knee arthroscopyvaricose vein procedures, and cataract surgery have now prepared a draft pan-London policy in their treatment areas.

Built into the programme is a ‘sense checking’ and feedback phase. Please note that this is not a consultation but an additional phase of the programme particularly seeking comments on how easy each draft policy is to follow and the clarity of the language used.  London Choosing Wisely is advisory and the statutory duty for approval of London-wide policies rests with each CCG governing body who will have the opportunity to further review, engage and consult in line with local governance processes, before making a decision on implementation.

Sense checking phase

The sense checking and feedback phase is now open for these treatment areas.  We invite comments from the London’s Healthwatch networks, patient associations and patients with an interest in these treatment areas via the following the online feedback forms:

The sense checking phase of the programme for all three draft policies will remain open until 9am Monday, 10 September 2018. 

Comments will be fed into the relevant expert groups, so that members – made up of primary and secondary care clinicians, public health experts, and patient representatives – can take on board feedback before finalising the draft policy.  Once agreed at Task and Finish Group level, each draft pan-London policy will be presented to the London Choosing Wisely Steering Group for approval of the review process and to ratify the policy.

What this means for patients

The aim of the programme is to reduce variation of care for patients across London by providing doctors with the latest evidence on what treatments should be offered to patients to achieve the best health outcome whilst also seeking to ensure that patients do not receive unnecessary treatment or intervention that will have little impact on their condition. The draft policies developed will be clear, easy to follow and use, and encourage conversations between patients and clinicians about the most clinically effective treatment available.

The programme will ensure a more standardised implementation of best practice and equal access to treatment that is consistent, clinically appropriate and based on robust evidence – all with a sharp focus on improved patient outcomes.

The London Choosing Wisely programme itself is advisory and the statutory duty for approval of London-wide policies rests with each CCG governing body who will have the opportunity to consult and debate the draft policies further, before making a decision. CCGs will further engage and / or consult locally, prior to implementation, as required.

“No health without MSK health”. Those were the words of our guest speaker at the ARMA AGM and they clearly struck a chord with members. They were on my mind last week when I attended a consultation meeting held by NHS England about the new ten-year plan for the NHS. At the moment MSK health doesn’t get as much profile as conditions such as mental health, cancer or cardiovascular. Not to downplay the importance of these conditions, but MSK health underpins all aspects of our ability to be independent and lead the active lives we want. We all know the cost to the NHS, to individuals and families, and to the economy is enormous.

The pain and limited mobility of MSK conditions also has a knock-on impact on other aspects of health – difficulty opening medication or food packaging; difficulty getting on the bus to shop for healthy food or attend appointments; difficulty carrying out all the self-care and self-management activities that enable us to manage other health conditions. Arthritis Research UK reports that by age 65 years, almost 5 out of 10 people with heart, lung or mental health problem also have a musculoskeletal condition. If you are struggling at home with your arthritis and you need to go into hospital for any reason, you are likely to need more support to return home as a result.

So why does MSK not get a higher profile? The answer is: at a local level it does. The majority of CCGs have MSK as a priority for service improvement locally. And at a national level NHS England has a plethora of relevant programmes and activity, it’s just they don’t all sit under the banner of a single MSK programme. By contrast, Public Health England has a new MSK programme which will be working on MSK initiatives and ensuring that MSK is embedded in other PHE work.

Wouldn’t it be great to see this all recognised with a profile in the ten-year plan? So as the NHS consults on the plan they will hear one message from ARMA members loud and clear: No health without MSK health.