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

Commissioning

The British Orthopaedic Association (BOA) is pleased to announce the recent publication of four revised commissioning guides with the Royal College of Surgeons of England. These NICE-accredited guides set out best practice care pathways to assist CCGs in designing optimal care for their populations. We are extremely grateful to all those involved in the rigorous development and accreditation processes. The guides, which can be found here, are:

  • Pain Arising from the Hip in Adults
  • Painful Deformed Great Toe in Adults
  • Painful Osteoarthritis of the Knee
  • Treatment of Carpal Tunnel Syndrome

Following the recent BOA and ARMA position statements on the rationing of elective orthopaedic services, we are urging stakeholders to consider these guides and to promote their adoption wherever appropriate with local CCGs. The use of these guides will assist CCGs to deliver high quality care in each of these pathways.

If you have any further questions, please contact policy@boa.ac.uk.

Arthritis and musculoskeletal conditions affect the bones, joints and muscles, and burdens the lives of so many people.

Musculoskeletal conditions are now the UK’s the biggest cause of pain and disability, accounting for an astounding one-in-five of all visits to the GP. Furthermore, trends indicate that more people than ever will be affected by MSK disorders in the coming years, which is why preventing them has never been more important. For this reason, the Arthritis and Musculoskeletal Alliance (ARMA), an alliance of prominent health charities, professional and research bodies, has produced a Policy Position Paper on Prevention of Musculoskeletal conditions.

The position paper highlights that a transformation is needed so that the care and public health systems go beyond merely tackling musculoskeletal conditions when they arise, to promoting good, lifelong musculoskeletal health. At every age people should be supported to maintain and improve the health of their joints, bones and muscles.

For more information about preventing musculoskeletal conditions, and to get involved in ARMA’s work, please get in touch via www.arma.uk.net and Twitter @WeAreARMA.

 

In early August, ARMA has published a Policy Position Paper titled:

‘Rationing’ Access to Joint Replacement Surgery and Impact on People with Arthritis and Musculoskeletal Conditions [document opens in pdf]

It deals with the damaging nature of thresholds and scoring tools, the problems of waiting times and restricted access to surgery, and how patients with musculoskeletal conditions are affected.

The Alliance is drawing attention to worrying trends in treatment access and the paper makes clear the key outcomes we are seeking from CCGs and the NHS.

Guest blog by Liz Lingard, NHS RightCare Delivery Partner

Over the past 3 months I have joined the ‘Whole System MSK events’ that ARMA and NHS England have organised as the RightCare speaker. This was an opportunity to clarify the RightCare approach to everyone working across the system and how they can apply this in their local health economies. The core aim of RightCare aligns to what each of the ARMA partners aspires to achieve: ensure the right person is able to access the right care in the right place at the right time, making the best use of available resources to help deliver a sustainable NHS. Identifying unwarranted variation and a greater focus on population health is now central to many of the national programmes. It is only when you review population data across a whole pathway of care that you are able to begin to understand variation of risk factors, prevalence of conditions, healthcare utilisation and outcomes of care. Identifying where there are the greatest potential opportunities for improvement is just the first step and further investigation is required to triangulate high level RightCare data (indicative data) with other national provider and local data sources alongside qualitative information from patients and providers (evidential data).

Before working as a RightCare Delivery partner, I was a Public Health epidemiologist who believed that ‘data was beautiful’ and using measurement for improvement was the key to success. Nick Milton wrote that ‘social connection and discussion is 14 times more effective than written word, best practice guidance, databases and toolkits’. So while I continue to work with the RightCare Intelligence Team to provide a better narrative around the data we produce, I am increasingly convinced that the face-to-face narrative we have at a local level between providers, commissioners and patients is the real key for making transformational change that is sustainable happen.

As a RightCare Delivery Partner working with CCGs, I know the enormous pressures they are under to make financial savings and how healthcare providers across all sectors are concerned about what this will mean for their services and patient care. I also know that in some local health economies there has been some really innovative transformational work. There was strong clinical leadership with engagement from all provider organisations working alongside CCGs and local authorities to optimally design pathways of care and ensure that these pathways were implemented in year.

Al Mulley recently reminded me of the story of the Fosbury Flop. At the 1968 Summer Olympics, after years of high jumpers making incremental improvements to their jumps, Dick Fosbury dramatically increased the heights that could be reached. He used a different technique that then became the dominant style and is still used today. No one had tried it because it sounded so wrong; it turned out to be the right thing to do. We are at a Fosbury Flop moment for MSK care where we can no longer make incremental improvements. So I encourage everyone to connect with the MSK work happening in their local networks and be part of the discussion to transform pathways of care that will reach new heights.

New research conducted by National Voices and Social Enterprise UK has found that only 13% of Clinical Commissioning Groups (CCGs) can clearly show that they are actively committed to pursuing social value in their procurement and commissioning decisions.

The Public Services (Social Value Act) 2012 requires commissioners to consider broader social, economic and environmental benefits to their area when making commissioning decisions. The Act was a response to the risk of competitive tendering focusing solely on cost at the expense of other forms of value. Consideration of broader social value when making commissioning decisions is vital to ensuring that the public pound is used as effectively as possible.

Download the full research findings.

BRITISH SOCIETY FOR RHEUMATOLOGY AND ROYAL COLLEGE OF GENERAL PRACTITIONERS LAUNCH INITIATIVE TO IMPROVE CARE PATHWAYS FOR PEOPLE WITH INFLAMMATORY ARTHRITIS

In May 2017, BSR and the RCGP have launched a joint Quality Improvement project to improve care for people living with inflammatory arthritis. The joint project will deliver a suite of online resources to help improve pathways between primary and secondary care, with a focus on reducing delays to diagnosis and creating standardised, shared care agreements. The recent National Clinical Audit for rheumatoid and early inflammatory arthritis revealed delays in referral from primary care to specialist treatment for people with suspected inflammatory arthritis, with only 17% of cases being referred within the three days recommended by NICE. Early diagnosis and treatment is crucial to prevent joint and organ damage and reduce potential disability.

Furthermore, once people are established on a treatment plan, their care is shared between primary and specialist care through joint agreements on prescribing and monitoring of high-risk drugs such as Methotrexate.  These shared care agreements are numerous and vary from locality to locality; there is therefore an opportunity to reduce risk by standardising and streamlining these agreements.

This one-year initiative will be led by the newly appointed RCGP Clinical Champion for Inflammatory Arthritis, Dr Danny Murphy, a GP principal in Devon with a special interest in rheumatology, who also works as a part-time staff-grade rheumatologist at the Royal Devon and Exeter Hospital. In addition to various research projects in rheumatology, Danny has also advised on the development of the recent BSR guideline on Biologics for the Treatment of Axial Spondyloarthritis.

Inflammatory arthritis affects close to a million people in the UK and includes conditions such as Rheumatoid Arthritis, Axial Spondyloarthritis and Psoriatic Arthritis. This project, in conjunction with the ongoing work through the national audit, will make a significant impact on care for people living with these conditions.

 

Commenting on the collaboration, BSR President, Dr Peter Lanyon, said:

“This new collaboration between BSR and the RCGP is a really important strategic initiative, aiming to improve the care pathways for people who live with inflammatory arthritis. We greatly welcome the appointment of Dr Murphy as the first ever RCGP Clinical Champion for Inflammatory Arthritis. This will undoubtedly raise awareness of these conditions across the RCGP membership and beyond. It’s a great opportunity for clinicians in primary and secondary care to work more closely together to develop national solutions to help reduce delays to diagnosis and deliver better co-ordinated care.

This is a view echoed by Professor Helen Stokes-Lampard, Chair of the RCGP, who stated:

“We’re delighted that the College is partnering with the BSR to raise awareness of this important clinical area in general practice. This collaborative project aims to support our members and their practice teams in the identification and appropriate management for patients living with Inflammatory Arthritis throughout the UK. I look forward to being involved in this project, and following its progress and the impact it has on GPs, our teams and our patients.”

Expressing his honour at being appointed, Dr Danny Murphy, the new Clinical Champion remarked, “I am very proud to be the RCGP’s first Clinical Champion for Inflammatory Arthritis, and am looking forward to working closely with the RCGP and BSR over the next year. Our aim for this project is to empower primary care practitioners to deliver the best possible care to patients with Inflammatory Arthritis, by focusing on eLearning, curriculum updates and engagement with commissioners.”

Putting forward models of care and examples of practice for the NHS is a large part of how Sport and Exercise Medicine (SEM) is influencing the MSK landscape. The Faculty of Sport and Exercise Medicine’s Fresh Approach in Practice NHS information document remains useful and relevant when communicating what works and how SEM can improve outcomes and make real cost savings in MSK care.

Members and Fellows of the FSEM are now putting forward their evidence for SEM-led MSK services to help provide much needed examples. Recently featured in the FSEM’s response to the Scottish Preventative Agenda Inquiry was NHS Tayside MSK Clinic, put forward by Sport and Exercise Medicine Consultant Dr Niall Elliot, which over a 10 year period, seeing approximately 800 patients per year in one session per week, has created a £500k – £650k saving for the NHS.

 

Shared decision making pilot

Arthritis Care has expanded our unique service into South Tees. The local CCG has commissioned a pilot, recently launched, which uses a shared decision making tool to help people with arthritis considering knee and hip replacements to explore their options and learn about self-management techniques.
 
Green paper response

In our response to the Work, Health and Disability Green Paper, Arthritis Care welcomed the focus on musculoskeletal conditions but urged the government not to force people to engage with employment support if they are not well enough.

Our response is available here.
 
You & Yours

Arthritis Care has recently contributed to BBC Radio 4’s You & Yours programme, along with a number of other arthritis charities, for their three day mini-series on arthritis.

The series aired between 22-24 February 2017 and focused on work and arthritis, young people and arthritis, and treating arthritis. You can listen to the first part here.