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 33 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Health Policy

NASP logoOctober saw the launch of a new National Academy for Social Prescribing (NASP), to champion social prescribing and the work of local communities in connecting people for wellbeing. Its objectives include exploring new ways of sourcing statutory and non-statutory funding and brokering relationships between different sectors. Given the prevalence of MSK conditions, it is important that social prescribing has something to offer for MSK.

The NHS Long Term Plan includes plans to recruit over 1,000 trained social prescribing link workers by 2020 to 2021, with the aim of 900,000 people being referred to social prescribing schemes by then. In some parts of the country, patients with long-term conditions who have had access to social prescribing link workers have said they are less isolated, attended 47% fewer hospital appointments and made 38% fewer visits to A&E.

The Chair of the NASP is Helen Stokes-Lampard, who as a GP will be all too aware of the importance of MSK conditions to the NHS. ARMA will be working to raise MSK so that link workers understand the importance of MSK and the types of community support, including peer support from patient groups, which can help.

More information on the NASP website.

ARMA joins Public Health England and the Centre for Ageing Better to make England the best place to grow old, because musculoskeletal health is vital to healthy ageing.

ARMA joined over sixty high-profile organisations in the UK’s health, housing, employment, research and voluntary sectors to launch a landmark shared vision on healthy ageing.

There are five key principles: prioritising prevention and public health; creating opportunities for people to contribute to society as they age; fostering accessible and inclusive homes and neighbourhoods so everyone can live where they want; narrowing inequalities in healthy ageing; and challenging ageist language, culture and practices.

This initiative is led by Public Health England (PHE) and the Centre for Ageing Better. We will work together with these and others because musculoskeletal health is vital to a good later life.

Find out more from the Ageing Better website.

Guest blog by Amanda Woolley, Policy and Implementation Lead for the Elective Care Transformation Programme at NHS England and NHS Improvement

The NHS Long Term Plan set the ambition to reduce outpatient attendances by a third over the next five years. Rheumatology services are leading the way in developing alternatives to the traditional outpatient model so that patients can access the support and treatment they need, at the time they need it.

Most people seen by rheumatology services will have chronic, long term conditions, such as rheumatoid arthritis and will require continuing specialist input to support management of their condition. In fact, rheumatology sees more follow-up attendances for each new first attendance than any other high-volume specialty after oncology and haematology.

However, the traditional outpatient model of routinely scheduled appointments at three, six or twelve month intervals rarely provides an optimal level of care for these patients. With a routine appointment, patients have to attend hospital even if their symptoms are currently well managed. This can be inconvenient and costly for the patient and is an inefficient use of NHS resources. Conversely, patients are not always able to get the support and treatment they need at the time they need it when their condition worsens.

Unsurprisingly then, rheumatology services are paving the way for transforming how to deliver ongoing specialist care for those with long term conditions. New approaches to outpatient delivery established in rheumatology settings include patient-initiated follow-ups, telephone clinics, use of remote monitoring apps, and better education programmes to support self-management. In addition, rheumatology services have taken the opportunity of using specialist allied health professionals, nursing staff and pharmacists to ensure timely access to the right support for managing different aspects of these chronic conditions.

While there are numerous examples of innovative practice, these approaches are not universally implemented across England. The challenge over the next five years is to learn from what has already been achieved and spread this to all areas of the country, both in other rheumatology services and across other specialties.

The Elective Care Transformation Programme supports local health care providers and commissioners to make sure that patients requiring a specialist opinion or treatment see the right person, in the right place, first time and every time. We are delighted to partner with ARMA in hosting the Rheumatology follow-ups: Transforming Outpatients webinar to share the learning of what is already in place and discuss the barriers to further implementation across rheumatology and beyond.

Anyone involved in redesign of outpatient and elective care services is welcome to join our online community of practice where they will find information and guidance for outpatient transformation across 14 high volume specialties and numerous potential interventions and ideas for service redesign. The community of practice also hosts online discussion forums and regular webinars where members can ask questions and share ideas.

To join the elective care transformation community of practice, email ECDC-manager@future.nhs.uk.

In September, Public Health England published a report on their review of the scale, distribution and causes of prescription drug dependence, and what might be done to address it. This included findings on opioid use for non cancer pain. The report made recommendations for action to reduce the problems caused by dependency and stated that effective, personalised care should include shared decision-making with patients and regular reviews of whether treatment is working.

Long-term prescribing of opioids for chronic, non-cancer pain is not effective for most patients. PHE’s analysis shows that, in 2017 to 2018, 5.6 million patients were prescribed opioid pain medicines for non cancer pain and that there are large variations across clinical commissioning groups (CCGs). After a long increasing trend, the annual number of prescriptions for opioid pain medicines has slightly decreased since 2016. Prescribing rates for opioid pain medicines had a strong association with deprivation, being higher in areas of greater deprivation.

See the PHE website for more details of the report and the implications for patients.

NICE are developing Interventional Procedures Guidance: High tibial osteotomy using a magnetic rod device for insertion for precise alignment in early knee arthritis IP1762.

In medial knee osteoarthritis, the cartilage in the inner part of the knee joint wears away. This can cause the joint to become lopsided, which can cause pain, stiffness, and difficulty bending and straightening the knee. In this procedure, a cut (osteotomy) is made in the top of one of the bones in the lower leg (tibia) and a magnetic nail is inserted into the bone. The nail can be rotated, lengthened or shortened using an external remote controller to adjust the shape of the leg. Once the bone is fully healed, the nail is removed. The aim of the procedure is to straighten the leg and relieve pain and maintain movement.

How to get involved:

Check the website to see how you can get involved. You may be able to help NICE in the following ways:

  1. Provide an organisations submission to share your views on the procedure by 22 January 2020
  2. Publicise the patient questionnaire with your network to encourage people that have had the procedure to share their individual views and experiences by 22 January 2020.
  3. Comment on the draft guidance – this will be made available on the NICE website following committee meeting one
  4. Publicise the public consultation, once open, on your website, social media streams, newsletter etc.

There will be two separate committee meetings to discuss this guidance. The first will be to discuss the evidence and produce draft recommendations, and the second will be to discuss the consultation comments.

Both committee meetings will be held in public. If you would like to observe these meetings then please register via the website.

About Interventional Procedures

NICE interventional procedures guidance covers two key areas:

  • the safety of the procedure or operation
  • whether it works well enough for use within the NHS

Recommendations about the use of interventional procedures are made to NICE by the Interventional Procedures Advisory Committee (IPAC). The Committee has 24 members, which includes two lay members, who are all independent of NICE.

 

 

A NICE draft guideline on joint replacement (primary): hip, knee and shoulder and its supporting evidence is now out for consultation.

Comments can be submitted on the draft guideline to help ensure that the guideline considers important issues. The consultation page has all the information and documents to comment.

The Developer has produced an economic model to support the guideline. An executable version of this model is available on request and will be released on receipt of a completed confidentiality form.

The consultation closes at 5pm on 26 November 2019. The guideline is expected to be published on 25 March 2020.

ARMA and its members have responded to the Government’s Green Paper: Advancing our health: Prevention in the 2020s.

ARMA welcomed the high profile of musculoskeletal conditions in the green paper which is important given that it is a fundamental building block of health and important for pain-free mobility.

Action is required by all parts of the NHS and local authorities as well as community groups, businesses and employers, to create the environment that will enable good lifetime MSK health.

ARMA responded with a consensus view of MSK patient and professional organisations. 
Read the response [pdf]

by Simon Chapman, Deputy Director, Personalised Care Group, NHS England.

Twelve years ago I was working for a charity just north of Kings Cross. My office looked out on a derelict area of forgotten buildings and toxic land. Over the next 10 years, things gradually changed as the infrastructure was renewed: old buildings were renovated and new spaces and buildings were created for people and communities to visit, use and inhabit. Now, where there was wasteland, parents watch their children play in the Granary Square fountains. It’s a terrific example of well-designed development infrastructure providing a framework that enables life, community and wellbeing to flourish.

And NHS England is taking a similar approach to expanding social prescribing, as part of an expanded team of people working in general practices. We are definitely not approaching it from a standing start, and we are not taking the credit for what is a vibrant social movement that many have worked in for decades. Across the country people have been working in communities to support activities that are good for people’s wellbeing. But, like the landscape I saw from my old office, social prescribing in primary care needs some design principles and infrastructure to be resilient, robust and widespread.

Our commitment in the Long-Term Plan is to have at least 1000 trained social prescribing link workers in primary care networks (PCNs) by 2020/21, and more beyond that, so that at least 900,000 people can be referred to social prescribing by 2023/24. This is the largest investment in social prescribing made anywhere by a national health system. And it’s not happening in isolation: social prescribing is one of six components of the NHS’s comprehensive model of personalised care.

We intend to secure a sustainable future for social prescribing in primary care so that it’s available for all who need different forms of support. Community approaches and social prescribing are at the heart of the NHS’s vision for its next 70 years. No longer nice to do; central to the future. That’s why we have built funding for the new link workers into the new GP contract so that it has contractual protection.

Social prescribing may not be new, but our ambition to make it universally available is. Achieving this means we must keep to some clear principles. Building on existing know-how for what makes effective social prescribing, we have worked with current social prescribers, as well as the voluntary sector and people with lived experience, to co-produce a standard model for social prescribing. It’s captured in a summary guide.

Perhaps the most radical thing about link workers is that they are employed to give people time. They will have the time and the space to work alongside people often with complex needs and life circumstances. They can help people who may become isolated, whose innate gifts have become buried deep, providing time and relationships that are critical to building confidence and reconnecting. Or they might support people for whom movement is difficult and life is challenging, by helping them to connect with walking, dancing, gardening – or other forms of community activity that helps to keep them moving and connected.

Link workers in primary care will become part of the networks of support that exist in communities. Although the GP’s surgery is often a place people come to when they don’t know where else to go, health services are only part of the picture. It’s been estimated that at least 20% of people consult GPs for what is primarily a social rather than a health issue. Link workers will be able to connect people with debt, benefits and financial advice, housing support, as well as community-based activities and support. There are many possibilities, depending on the person’s priorities and what’s available locally, including: walking and other outdoor activities; arts, singing and cultural groups; sport and exercise; lunch clubs.

Successful social prescribing in primary care will work alongside what’s already happening in communities and the local system, enabling people to build on strengths that are already present.