Arthritis and Musculoskeletal Alliance
This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.
  • 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 40 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Guest Blog

Guest blog by Professor Anthony Woolf, Chair, ARMA

[Republished from the NHS England blog]

Musculoskeletal (MSK) conditions have a huge negative impact on the health of the population.  People with MSK problems making a first approach to health services can find it difficult to access the right support and some experience delays in getting the correct diagnosis and management, which can result in prolonged impact such as ongoing pain and work loss.

Launched a few weeks ago, the Musculoskeletal core capabilities framework for first point of contact practitionershas been developed in partnership by the Arthritis and Musculoskeletal Alliance (ARMA), NHS England, Skills for Health, Public Health England and Health Education England to ensure that people with MSK problems get what they have expressed they want – rapid access to diagnosis and early management advice, being fully involved in their care through shared decision-making and self-management. They want confidence in the advice they are receiving and in the capabilities of the health practitioner, their problems and concerns understood and responded to and they want a holistic approach to their problem.

This framework aims to ensure that the range of healthcare professionals who work with patients with MSK problems can play a full role in helping to manage any MSK problem appropriately at the first point of contact.  Working in a team and sharing challenges, first contact MSK practitioners can ensure the person with an MSK problem gets rapid access to the right support without the person getting lost in what can feel like a maze of different care pathways. The first point of contact is important to ensure that potential emergencies are recognised and that the next step in the pathway occurs seamlessly and as efficiently as possible.  This will also help relieve pressures on primary and secondary care. 

By making it clear what capabilities are required, we hope the framework will encourage training and development to increase the number of practitioners from different professions who will fulfil this vital role. Importantly, this is not about creating a new MSK workforce as many already fulfil this role, but is about recognising existing capabilities within practitioners’ scope of practice and ensuring services are delivered consistently by multi-professional teams.  One challenge might be that we have all become too ‘specialised’ in healthcare, but the person with the MSK problem wants and needs a holistic approach to get the best outcome.

This framework of core capabilities offers clear definitions against which to improve and assure – for employers, clinicians, regulators, primary care training hubs, commissioners and practitioners themselves.  It also emphasises the need for modernised skill sets that support person-centred approaches and include shared decision-making, prevention, and support self-management and focuses on what enables people to stay active and independent.  Most importantly it will give the public assurance of the capabilities of the person they are seeking help from.

There is a growing consensus across health and care for new approaches and targeted interventions to promote healthier ageing. This framework has been developed by the whole musculoskeletal sector – including patients and health professionals – collaborating on an issue we all agree is important. It is focused on the needs and expectations of people with MSK problems; with recognition by the health professions that there needs to be harmonisation of core capabilities across the sector to ensure that the right care is provided from that first point that someone presents with an MSK problem seeking a solution.

ARMA is pleased to have played a part in creating this framework that should make a real difference to patient outcomes.

Guest blog by Ms. Nuzhat Ali, National MSK Lead, Public Health England

Health inequalities are avoidable, unjust differences in people’s health that are persistent and difficult to shift, until and unless we actively focus on them as a society and a whole system.

People living in the most deprived areas in England can expect to spend nearly 20 fewer years in good health compared with those in the least deprived areas. The trajectory and the scale of the inequity worry me for at least three reasons – it is:

  • A societal injustice, one that has serious consequences for us all in many ways
  • A factor in slowing down life expectancy and healthy life expectancy
  • Increasing demand for health care which equates to increasing costs

Health is dependent on so much more than healthcare.  Research from the Canadian Institute of Advanced Research, Health Canada, Population and Public Health Branch found that healthcare contributed no more than 25% to our health, and others like McGiniss et al found from their research that it is a 15% contribution. Our genes, lifestyle behaviours, environment, housing, socioeconomic and working conditions, and much more are all key determinants of our health. Surely this points to the need for us all to focus greater attention to these factors in meaningful ways.

The Determinants of Health (Dahlgren and Whitehead, 1991)

The figure above shows the main determinants of health as layers of influence. At the centre of the model, individuals are endowed with non-modifiable factors that influence health potential, including age, sex and constitutional factors.  

Surrounding the individuals are layers of influence that can be modified. The innermost layer represents the personal behaviour and way of life adopted, such as smoking habits and physical activity, with the potential to promote or damage health. Individuals interact with friends, relatives and the community, and are therefore affected by the social and community influences represented in the next layer. Mutual support within a community can sustain the health of its members in otherwise unfavourable conditions.

The wider influences on a person’s ability to maintain health include their living and working conditions, food supplies, and access to essential goods and services. Overall, there are the economic, cultural and environmental conditions prevalent in society as a whole, represented in the outermost layer.

What do we know about the relationship between musculoskeletal (MSK) health and inequality?

Gender differences:

An estimated 17.8 million people live with a MSK condition in the UK, which is around 28.9% of the total population. Of these, 7.7 million are men and 10 .1 million are women.

Socioeconomic differences:

People who live in the most deprived areas are much more likely to report arthritis or back pain than people in equivalent age groups who live in less deprived areas. 40% of men and 44% of women in the poorest households report chronic pain, compared to 24% of men and 30% of women in the richest households.

Among people aged 45–64, the prevalence of arthritis is more than double in the most deprived areas (21.5%) compared to the least deprived areas (10.6%). Further, people of working age (45–64 years) are almost twice as likely to report back pain (17.7%) as those from least deprived areas (9.1%).

Physical inactivity, obesity and comorbidity are all strongly associated with deprivation. People in the most deprived areas develop multi-morbidity 10–15 years earlier compared to those in the least deprived.

My top three humble suggestions on how we might tackle this wicked system problem:

  • Balance the medical model of health with the social model of upstream efforts on wider determinants of health. This means working in partnership and collaboratively across sectors and with our community’s
  • Focussed secondary prevention in primary care is the best way to get quick wins in narrowing health inequalities (King’s Fund)
  • Provide targeted support to help people find and remain in good work

Public Health England (PHE)’s mission is to protect and improve the nation’s health and wellbeing, and reduce health inequalities. PHE have published a range of tools and resources to support professionals to tackle inequalities. PHE’s guidance – Reducing health inequalities: system, scale and sustainability – set out a revision of the DHSC’s Health Inequalities National Support.

For further information, you can visit PHE’s return on investment tool for MSK conditions, Health Matters and the recently published review on muscle and bone strength and balance.

Guest blog by Tom Embury, Public Affairs Officer, British Dietetic Association.

The Allied Health Professions most commonly associated with arthritis and MSK conditions are probably our colleagues in Physiotherapy and Occupational Therapy, but the British Dietetic Association (BDA) believe dietitians have a key role to play in supporting patients and working with colleagues as part of multidisciplinary teams to prevent and treat these conditions.  

The BDA is one of the world’s oldest nutrition and dietetic bodies and represents the 9,000 or so dietitians working in the UK, as well as students, dietetic assistants and affiliate members. It is well established that diet has an important role to play in protecting against or helping to manage conditions such as osteoporosis and arthritis.

Being overweight or obese is also a key risk factor for MSK conditions, and diet is the single biggest factor in causing or reversing obesity. It is also increasingly obvious that the relationship works the other way, with conditions such as arthritis making eating and preparing food more difficult, and increasing the risk of malnutrition, especially amongst older people.

Joining ARMA is part of the BDA’s efforts to highlight and develop what dietitians do in a wider range of roles, conditions and sectors. In particular, we are currently prioritising the central role we think dietitians can play in prevention and public health. It was the theme of our recent Dietitians Week campaign, which is now in its fifth year, and preventing and managing MSK conditions was one of the many varied roles we featured.

We’re looking forward to learning more from colleagues in this field and contributing the BDA’s perspective to the work of the Alliance. We’re keen to share our resources through the MSK Knowledge Hub, such as our Free Food Fact sheets, which include specific dietary advice for osteoporosis and osteoarthritis, as well as more general health eating advice and nutrient specific information on calcium or vitamin D. We hope by adding our voice to the alliance we can help to transform the quality of life of people with musculoskeletal conditions.

by Dr Steven Boorman CBE, Director of Employee Health, Empactis,
Chair of the Council for Work and Health

As I head towards the milestone later this year of passing my thirtieth year in occupational health, I find myself optimistic mixed with the “glass half empty” of recognising that the same barriers remain in place: barriers to those who want to work with long term conditions. Over my career I have worked regularly with ARMA members and experts, and I have personal experience of working with a MSK condition.

The recent “Improving Lives” consultation and subsequent Government Strategy paper highlighted that since 2013, 400000 more people have become disabled (rising to over 7 million across the UK) and 3.7 million people have a musculoskeletal disorder, yet only 1.7 million of these are employed.

For people of working age without a disability the employment rate is around 80% but for those with disabling conditions the figure is 46%.

Let’s be clear, I do understand that for some people employment is not feasible. However, we do know that, providing it is good work, work does benefit your health. The social, financial and other benefits of work activities can improve many conditions, including many MSK conditions, reducing disability and frequency of recurrence or exacerbation. My profession, occupational health, isn’t about trying to force those that can’t to work, to do so risks harm and isn’t good for employers or employees! On the contrary it is about helping those that want to work to match their health conditions to the work available … which is easy to say, but can be challenging, particularly if a condition such as a MSK disorder has symptoms that vary over time and may be unpredictable in its impacts.

But my reflection here is that whilst we know such conditions are painfully common, we haven’t yet managed to adapt our health, social care and employment practices to adequately help those that want to be in work to be there.

Let’s start with sickness certification. It’s not always easy to see a GP, and whilst conceptually the idea of changing a sick note to now include an option to advise an employer about potential work adjustments is a good one, the reality is that many GPs lack the training or the time to adequately explore options during a short clinical consultation. My time spent working to improve disability assessment also taught me how difficult it is to adequately consider changing function with time and so, in the mistaken belief that it’s the safest option, often it’s easier to say “unfit for work”.

Annually 300,000 people become sick and lose their jobs and come in to the benefits system, many with MSK, often also associated with other conditions. Benefits assessments focus on the information collected on the day and don’t consider the barriers or practical difficulties that prevent work. If things improve to enable a consideration of returning to work, the risk may be loss of benefits and a long wait and further assessments to get them back, and the challenge of finding employers (even given the requirements of Equality legislation) willing to adapt and match work to physical needs can also be hard.

Occupational health advice may help, but “Improving Lives” shows clearly that it is not there for many – many, particularly smaller, employers have limited knowledge or access to OH and to be brutally honest the quality and experience of OH providers to cope with complex fluctuating conditions can be poor. Again, Occupational Health assessments are often undertaken at a point in time and whilst they will include consideration of symptoms and disability changing, flexible working adjustments can be hard to create.

At its simplest, what’s needed are mechanisms to enable a person who wants to work with a long term and changing medical problem to be able to interact with their employer / manager without delay and with the capability to change work to match needs at the time. Again, I recognise that this isn’t always feasible or practicable, but now working for a technology firm, I realise that real-time solutions are achievable, but under-utilised. Given the right and timely information most employers want to support their employees to enable work, but poor communication and understanding often makes this difficult.

Eric Topol, the American Cardiologist and technology pioneer, criticised the medical profession for being too slow to change and adapt. I find myself today reflecting that, whilst the “Improving Lives” work rightly highlights the needs to make changes in the way we operate our health and social care systems to improve the chances for people who can to work, to make this feasible we have to make it easy – easy for employers to know what’s needed and how to meet those needs; easy for the employee to understand and communicate those needs; and easy for the care systems to support needs as they change.

I hope it doesn’t take another thirty years for this to happen, and as I learn more about what changing technology can do, I am optimistic that it won’t!

Guest blog by David Albury, Board Director Innovation Unit

Why have so many innovations in the NHS failed to make the impact they might because they remain in isolated pockets and never spread? Here at the Innovation Unit we decided to look at this question from a more positive angle and ask where innovation has spread and what made that possible?

There is broad agreement that the pressures and challenges currently facing the NHS can only be addressed through developing and scaling innovations that significantly improve outcomes whilst significantly reducing costs. This is as true in musculoskeletal services as in other sectors.

But proven innovations and best practice tend to spread slowly in the NHS. Innovations such as first contact physiotherapist or ESCAPE-pain remained as isolated pockets of good practice long after they had been shown to be effective. ESCAPE-Pain is now rolling out in many areas, thanks to a grant from Sport England, but the first evidence that it worked was as long ago as 2007.

The barriers to spreading innovation have gained a lot of attention. The Innovation Unit, in collaboration with the Health Foundation, wanted to look at the enablers – what will help the spread of good practice. We looked at ten examples of successful spread of innovation in the NHS. Our report identifies common factors that enabled their spread. Whilst none of the case studies were in MSK, the key enablers we identified will apply equally well to MSK innovation.

Our eight key enablers

In pursuit of spread:
1. Building demand through existing networks and narratives
2. Using evidence to build demand
3. Balancing fidelity, quality and adaptability
4. Scaling vehicles rather than lone champions

Creating the conditions for spread:
5. Capitalising on national and local system priorities
6. Using policy and financial levers to kick start momentum
7. Commissioning for sustainable spread
8. External funding to support spread

Read Against the Odds for more on the eight key enablers and some provocations for system leaders, funders and innovators. We hope you will find it useful as you face the challenges of how to spread innovation and good practice in MSK across the NHS.

Guest blog by Satjit Singh, Chief Executive, Society for Promoting Chiropractic Education

It is great that most of us will live to an age that our parents could never imagine. Better living standards, improved public health and an NHS accessible to all, have all helped.

This is excellent, but living longer means that we are likely to be working longer. It also means that for us to enjoy that longevity, we need to live active, fulfilling lives. Too many of the population are afflicted by ‘aches and pains’, mainly back and neck, i.e. musculoskeletal. This not only has physical implications, but like so many chronic problems, has effects on mental health too.

Musculoskeletal problems are responsible for 30% of visits to a GP 1 and have an enormous impact on the quality of life of millions of people in the UK; 10.8 million working days are lost as a consequence of musculoskeletal conditions1. Our healthcare sector, already under so much strain, has to cope with the burden of an increasing number of people presenting with MSK issues; our economy certainly cannot afford to lose so many man-days.

Not only are we faced with an increasing MSK burden, we also lack the healthcare resources to deal with it. NICE recommends manipulation as part of the package of care to deal with this; however, regulated manipulative therapists, comprising mainly chiropractors, osteopaths and some physiotherapists, are nowhere near what the country needs. We only have 3,000 chiropractors, 5,000 osteopaths and some 1,100 physiotherapists who are members of the MACP 2, trained to undertake manipulation. We need more, many more. Not only do we have an ageing population, our health workforce is ageing too. We have seen the consequences of that amongst GPs; other professions are also not immune! The ability to access a ready pool of healthcare professionals from Europe, will reduce significantly, post-Brexit.

Looking around at the chiropractic profession, I saw that there were only three universities in the UK offering chiropractic degrees. Many schools in the country were not even aware of the profession, to make it available as a choice to their A-level students. Given the current rates of growth in the UK profession, it would take over a century to achieve current rates of chiropractor access in Canada or Denmark.

That is why The Society for Promoting Chiropractic Education was established last year. Launched by George Freeman MP, former Life Sciences Minister and Chairman of the Prime Minister’s Policy Board, it aims to encourage school leavers to consider a career in chiropractic; whilst simultaneously working with universities to offer chiropractic degree programmes.

London South Bank University has launched a new four-year masters course in chiropractic and students will start their course in Autumn 2018. What is especially important, is that students will learn in multi-professional settings alongside others studying physiotherapy, nursing and occupational health. This will ensure that future graduates understand how they fit into the wider health landscape. Other programmes are planned in poorly served geographical locations.

Our aim is to work towards a situation where healthcare professionals practising manipulation become part of direct access arrangements within GP practices. For that to happen, we need more of them.

References

  1. https://www.england.nhs.uk/ourwork/ltc-op-eolc/ltc-eolc/our-work-on-long-term-conditions/si-areas/musculoskeletal/
  2. https://macpweb.org/home/index.php?p=366

Guest blog by Alison Trewhela, Director of the Yoga for Healthy Lower Backs Institute

Evidence-based exercise for people restricted by back pain, fearful of movement, in considerable pain, or with other illnesses and injuries, ‘Yoga for Healthy Lower Backs’ (YHLB) is a gentle 12-week mind-body exercise programme offering a potentially life-long solution.

Public Health England has recently included YHLB as one of seven evidence-based MSK options in their PHE MSK ROI Return on Investment Interventions report and online tool. Healthcare and public sector commissioners and well-being providers are hereby more easily able to choose cost-effective innovative interventions. YHLB shows a £10 return on investment for every £1 spent.

The ‘Yoga for Healthy Lower Backs’ programme was born out of a large research collaboration of academics, health economists, yoga teachers and back pain specialists led by The University of York and funded by Arthritis Research UK. The 313-participant randomised control trial compared this yoga programme and usual GP care against usual GP care and evaluated back function at the end of the course as well as 12 months later.

The findings showed that YHLB was effective for chronic low back pain for the long-term (Annals of Int. Med., H. Tilbrook et al, Nov. 2011; Vol 15 No 9).

An economic evaluation showed that YHLB would be cost-effective within the NHS, was a dominant treatment for society, and that it reduced work absenteeism by 70% over the 12 months studied (Spine Journal, 15th Aug 2012, LH Chuang et al).

To share this research and knowledge, as the lead yoga research consultant and designer of the YHLB programme, I have trained over 400 experienced yoga teachers nationwide and, along with others, have set up a social enterprise and training Institute. Teaching teams and regional Hubs are being established to improve ease of access.

Our ‘best practice’ ‘Yoga for Healthy Lower Backs’ structured programme was designed to offer person-centred self-management support and advice. Uniquely, it is unparalleled in its strong evidence-base.

Attendees learn how to use strengthening, mobilising, stretching and pain-relieving poses, relaxation and breathing techniques and postural awareness exercises that aid a return to normal activity levels at work, home and leisure. They gain extra psychological support from group learning and benefit from positive ‘side-effects’, such as reduced time off work and improved mood.

Importantly, this is a specialised yoga course, designed for those with persistent, episodic or recurring back pain. However, it is equally true that if you have a lower back (!) and want it to be healthy, you can attend this gentle yoga course and learn how to help yourself to improved comfort, health and well-being for now and the future.

It is a ‘mind-body package of care’ that can easily be integrated into daily life. Offering a manual, relaxations CD, practice sheets and hand-outs, the 12 classes teach people to self-manage their back pain, whilst encouraging long-term changes in increased physical activity and improved well-being. A recent study showed that YHLB attendees had a 63% improvement in feeling able to manage their back pain by themselves.

Through ARMA, we have been able to connect with many organisations in the musculoskeletal field with which we share similar goals. Through these connections, we are continuing to make progress in taking the results of the research out to those that it would most benefit, i.e. those with back pain, but also health professionals and commissioners.

Amongst other regions, the YHLB programme is being successfully piloted by the NHS in Cornwall, as follows:

  • GP surgeries (n=5) subsidizing course costs
  • ‘Social prescribing’ scheme
  • Subsidised courses for Primary Care staff
  • Teaching Team and Regional Hub

The evidence from the research contributed significantly to the evidence NICE evaluated in their Guidance on low back pain and sciatica which mentions mind-body exercise, such as yoga, as a first step to managing low back pain.

In the light of the recent Government Paper Improving Lives, The Future of Work, Health and Disability, a social franchising model to take this successful and evidenced Yoga forward as an early intervention treatment option is being explored. The Government paper states “Early intervention and access to treatment and support were critical to preventing the progression of ill-health and preventing people falling out of work.”

One YHLB course attendee called it “a life-changing experience after years of frustration.”

As a specialist tutor for Yoga and Research at University of Exeter Medical School, I know how hard is has been in the past to find yoga programmes with strong evidence-base, so all this is fantastic news for those with back pain, referrers and commissioners.

Further information at www.yogaforbacks.co.uk or email YHLBInstitute@gmail.com

by Jane Green BSc. (HONS) Psych., PGCE, Av.Dip. Ed. Child Development, MA Ed.  (Leadership and Management / autism)

Why did I stop working in my professional career?

Two-and-a-half years ago I medically retired. This was after years of pain following full dislocations; half-dislocations; sprains; tears in joints, muscles, ligaments and tendons; and arthritis. I received my diagnosis of Ehlers-Danlos syndrome 3 (now hEDS) and associated conditions later that year.

As a child, I did have a few problems with joints and did ‘party tricks’. Whilst bringing up my sons, one with significant medical and neurodevelopmental difficulties, I was passionate about improving autism practice. The OU offered me opportunities without my needing previous qualifications. I won two awards. I had two knee operations in 2003 but was not offered any physio afterwards. It took me nearly a year before I could walk unsupported. In 2006 I was shortlisted for the EP doctorate and offered a place. Unfortunately my knees were unstable and deconditioned, so it made commuting to London impossible. My career then comprised of schools: I was special needs teacher at Young Epilepsy, Advisory teacher for the Local Authority, Lead Educationalist/consultant for the National Autistic Society and Autism Education Trust, Strategic Assistant Head teacher and DfE Autism Education Trust trainer for Ambitious about Autism.

Often, as key speaker at conferences, I would approach the rostrum wearing a microphone and all you could hear were bones crackling, snapping and occasionally popping. There would be a stunned silence. At first I tried to ignore this, but with experience I learned to announce the additional noises to the audience. Speaking at MDT meetings I had time to talk to smaller groups on their tables. I soon came to recognise the look on the face of some delegates (disbelief- face), knowing then to check if my arms or legs were out of place and adjust them, whilst asking the delegates if they were occupational therapists/physiotherapists – which they undoubtedly were! As I was the key speaker holding conferences together it put a great responsibility on my shoulders (excuse the pun) just to be there. So I continued, despite multiple injuries, increasing inflammation and pain.

Throughout my career I tried to stay working. EDS is a variable condition, but without management it became unmanageable. I received drugs for inflammation and referrals to MSK departments. By then I received a diagnosis of hypermobility and discharged. Unfortunately, it took five months to be seen by MSK after the initial event (which was a dislocated ankle with several other injuries).

This delay meant:

  1.  I was not believed
  2.  I couldn’t remember all the facts or what it looked like five months before
  3.  the amount of time escalated other injuries

I was then told categorically “we all have aches and pains at [my] age”. This brought about a defence mechanism in me: I knew that medical resources didn’t know what to do with me. When my shoulder dislocated with tendon tears, I continued working with an increasingly painful but useless shoulder and arm. All this time, I was also a carer. My GP said there was a pain management course. However, the advice given was impossible for me. When I asked what to do as I was hypermobile, I was told ‘this isn’t a course for you’.

I had often limped and used a walking stick at work. Once, over a period of two days, an older injury to ankle ligaments resurfaced in my other foot, so I swapped the walking stick to support that leg. Comments made to me in the office were:

Oops, did you forget you were limping on the other leg last time?”
and “My son dislocated his shoulder but it popped back in and he just got on with it.

I found it difficult to explain to them how much pain I was in because I didn’t understand it myself. There a was no pathway and to some extent I thought that maybe everyone suffered like me.

The hot-desking policy at work caused me stress so I asked for a set desk, a chair with arms, a foot pedestal and drawer of files placed nearby. After a health assessment I was given a set place for ‘reasonable needs’. This meant me getting on the floor to dig out my foot rest, finding a chair that moved multi-directionally with hand rests, and a subsequent hunt for suitable drawers after my two-and-a-half hour commute.

I get a lot of muscle spasms which are agony. I tried to use the quiet room to stretch but it was never available. I was sent to my organisation’s physiotherapist, usually used for students and staff. The physiotherapist tried, but I recognise the face of confusion and disbelief quickly now. I was told to go elsewhere. My last injury meant that I could not sit down for over a year.

As EDS UK Support volunteer Area Coordinator for Surrey/Sussex, I was asked to attend the Crawley ARMA event and NHS England conference as patient speaker. EDS UK Support is proud to be a member of ARMA. As a small charity, membership is a great way of keeping up-to-date with changes in government policy that affects our community and it gives us a voice as part of an alliance when EDS doesn’t have the resources to do that type of work directly.

Guest blog by Robbie Turner, Director of England, Royal Pharmaceutical Society

With people living longer lives, the number living with multiple long-term conditions is rising, leading to billions of pounds in additional health and social care costs. This will be a scenario very familiar to the members of ARMA.

Treatment and support for the growing number of people with long term conditions such as arthritis and other musculoskeletal conditions is placing significant demands on the NHS and other public services. Around £15 billion was spent on medicines in 2015/16, which are the most common solution chosen to help manage symptoms for people with long term conditions.  Medicines can be life-prolonging and life-saving, but they can also cause side-effects or interact badly with other medicines being taken.

As the experts in medicines and their use, pharmacists can ensure people get the best outcomes from their medicines, reduce side effects, minimise harm and admissions to hospital, while ensuring resources are used more efficiently to deliver the standard and level of care that people with long term conditions deserve. 

We can also reduce the demand on GPs by freeing up their time to manage more complex or demanding cases.  For example, a group of 10 GP surgeries in York and Hull now employ three pharmacists who specialise in managing patients’ medicines. Each pharmacist can do, in 35 hours a week, work that was taking GPs 60 hours a week.  The quality of care around medicines has improved with quicker, more reliable prescribing. This has improved results for patients and saved the practice money which can be put towards other kinds of care.

That’s why there’s growing recognition from policy makers, fellow health care professionals and patients that pharmacists can play a key role in supporting high quality patient care as part of the integrated healthcare team.

There are pockets of examples of best practice for people with arthritis and musculoskeletal conditions where pharmacists have become part of an integrated team in the community and have improved outcomes for patients.

For example, working as part of the multidisciplinary team in the Rheumatology Department at North Bristol NHS Trust’s Southmead Hospital, the specialist rheumatology pharmacist, who is also an independent prescriber, has improved care for over 580 patients on biological immunosuppressant therapy for their rheumatoid arthritis through better monitoring and clinical reviews.  More robust prescribing and screening processes have improved patient safety and led to a six-figure saving for the Trust through increasing efficiency in systems and avoiding medicines waste.

Success stories such as this are growing in number, but are still the exception rather than the norm. They too often rely on committed individuals persisting to secure the kind of support required across the health professions for successful change. To replicate this practice across healthcare and create a more integrated workforce, the Government should establish a proper training framework which will allow all professional groups to work closer together to deliver patient care.

I look forward to the pharmacy profession playing a key role in this bright future.

by Mark Brandreth, NOA Lead CEO and
CEO of the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation
Trust

As the new lead CEO for the National Orthopaedic Alliance (NOA), I am proud to be part of a group of organisations and people who are working to drive improvements in orthopaedic care nationwide. I’m pleased to have been given the opportunity to contribute a guest blog to ARMA’s newsletter to share an update on our work with you. At Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH), our work with the NOA, and its vanguard work in particular, is vital to our future – and to the future of orthopaedic care received by patients across the country.

Ultimately, the NOA wants to improve the services that its members provide and through the vanguard project, create a framework (or pathway) others can follow leading to consistent high quality care for patients across the country. The objectives of the vanguard are:

  1. Agree what good looks like in orthopaedics and set a formal quality standard for this
  2. Recruit, assess and support members
  3. Grow membership across the country to spread provision of consistent high quality care
  4. Support the development of Quality Standards by members
  5. Support the development of a quality assured system for orthopaedic care

Progress with the vanguard to date has been centred on mobilising and recruiting members to help build our orthopaedic quality standards. Development of these standards is well underway and once launched will help ensure that patients, no matter where they are treated receive the same quality of care and are looked after using the same evidence-based, reliable and safe processes.

The success of the NOA so far has been driven by input from members and we are ever grateful for their support. Just recently, members contributed to producing The NOA Short Guide to Clinical Coding for Clinicians – a useful guide to help address an area needing attention across many NOA member organisations. More detailed guidance, including the full NOA suite of standards will be available to members once the vanguard launches its quality standards.

I for one am proud to be part of this movement. If you want to find out more about the NOA vanguard work, I encourage you to read the latest newsletter here. You can also follow @NOA_Vanguard on Twitter.

Guest Blog by Paul Hitchcock, Chief Executive, The British Acupuncture Council

I recently spoke at an NHS England event for International Day for Older People, my talk being titled “Lessons from traditional Chinese acupuncture – adding value to life”. We know we have a demographic challenge here in the UK and we talk about an ageing population that will see an increase of around one million people over the age of sixty five in the next three years. In China the number is closer to three hundred million, although the approach there is not to use age as the differentiator but the person’s overall health and wellbeing – an approach that is also now starting to be applied here in the UK.

Another major difference in the approach to health management is the integration of traditional acupuncture with western medicine – an approach endorsed by the World Health Organisation strategy, and the use of acupuncture earlier and in more conditions than it is often considered here in the UK. For example in China acupuncture is used as an early intervention in treatment following a stroke.

So what might be the lessons for older people here in the UK especially those who have an MSK issue as part of a complex pattern of co-morbidities?

Perhaps we should be considering a wider spread of therapeutic support than has been used in the past? For example what would happen if the range of therapies traditionally used by an acupuncturist trained in the eastern medical paradigm was added to the choices open to the patient? What would happen if the first point of contact for an MSK patient was a traditional eastern trained acupuncturist?

The integration of western ‘orthodox’ medicine and eastern ‘traditional’ medicine is a strategic intent of the WHO and is now being mandated in China where the problems of an ageing population dwarf those same problems here in the UK. Shouldn’t we also be integrating the two medical paradigms?

Guest blog by Catherine Pope, Chartered Society of Physiotherapy, Chair.

Jane left hospital after a stroke and was seen promptly at home by a physiotherapist, who worked with other members of the multidisciplinary team to develop a plan for her recovery.

Members of that team visited regularly, and Jane made strong progress – supported by her husband, Robert – towards achieving her goal of getting back out into her garden and getting her green fingers dirty.

Meanwhile, another Jane, in another part of the country – perhaps even the neighbouring town – realised no such goal.

It took weeks for her to be seen and even then, the service was so badly stretched that she and her husband, also called Robert, were largely left alone to make what limited progress they could.

You may have guessed by now that these stories are fictional, but both are based on the hard reality of the postcode lottery that patients face each year when leaving hospital after illness or injury.

They are the subject of a new film produced by the CSP, which we will launch later this month at a parliamentary event in Westminster.

It’s called “Rehab Matters” and is part of our broader campaign to raise the profile of community rehabilitation, particularly with politicians and healthcare decision-makers.

For too long, the issue has been overlooked in favour of acute sector problems.

We hope that by joining forces with ARMA and many other like-minded organisations, we can work towards a future in which no patient misses out on the truly transformative changes that high-quality rehabilitation delivers.