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

Health Policy

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.

by Duleep Allirajah, Assistant Director of Policy and Campaigns, RCGP

As any patient who struggled to book a GP appointment will know only too well, general practice in the UK is under immense strain. Demand for appointments is rising and GPs are seeing more patients with complex needs. At the same time, practices are closing, workloads are reaching unsafe levels and burnt-out GPs are quitting the profession. That is why the Royal College of General Practitioners decided the time was right to publish Fit for the Future, our vision for the revitalisation of general practice.

If general practice is to survive and flourish, it needs a radical overhaul. Sticking plasters will not suffice. GPs must embrace multi-disciplinary team working and collaborate at scale with neighbouring practices. But, we don’t want an impersonal, industrial-scale service. Continuity and holistic care must remain at the heart of tomorrow’s general practice. At scale, yes, but with a personal touch.

We consulted extensively with GPs and patients in developing our vision. What I heard time and again was that consultations were too short – the average length in the UK is less than 10 minutes. It’s time to rethink the consultation so that it works better for GPs and their patients. Our ambition is for the standard consultation to be at least 15-minutes or longer where necessary. The method of consultation will also change. Patients will also be able to access their GP surgery by video, online or telephone consultation. The relationship between GP and patient will also be recast. In future, patients will be treated as equal partners in their own care, shared decision making will be the norm, and medication won’t be the default option.

General practice in the future won’t just be delivered by GPs. It will be very much a team endeavour. Care will be delivered by multi-professional practice teams comprising a range of clinical and non-clinical roles. One of those roles is the first-contact practitioner, who can assess, diagnose and provide initial treatment for patients with musculoskeletal conditions (MSK). An audit of a service in Forth Valley NHS found that first contact practitioners were able to deal with 99% of MSK patients in GP surgeries. Services like these mean no lengthy waits for MSK appointments; they also free up GPs to focus their skills to where they are most needed – diagnosing serious health conditions and managing multimorbidity.

Will the expansion of practice teams erode continuity of care which, as the evidence shows, leads to better health outcomes? It is a risk which requires us to find creative solutions. The College is currently supporting the Health Foundation to test out innovative approaches to continuity’ – for example using ‘micro-teams’ – which can preserve the benefits of relationship-based medicine as general practice moves to multidisciplinary team working.

In our vision, GPs won’t just be working with a wider range of practitioners in their surgeries, they will also collaborate with neighbouring practices to deliver placed-based care for their communities. Too often today, practices are forced to merge because they are no longer financially viable. We want to see GPs collaborate at scale freely, not because they are compelled to but because it is the right thing to do. Ideally, GPs will shape and feel real ownership of these new networks or federations. There are huge benefits to working at scale, such as pooling back office functions or clinical staff and moving more services from acute to primary care settings. Over time, these GP networks and clusters will become well-being hubs, hosting a range of well-being, healthy living and community services. This way general practice can play a proactive role in preventing ill-health, reducing health inequalities and building community resilience.

Realising our vision will depend on several key enablers – increased funding, workforce capacity and skills, a radical upgrade of GP premises, state-of-the-art digital technology and more GPs engaged in innovation and research. Ours is an ambitious vision but not a pipe dream. With these building blocks in place we can not only deliver world class, patient-centred primary care, we can ensure that being a GP can be the best job in the world.

Following initial policy direction in the Advancing our health: prevention in the 2020s green paper in July, on Friday 16 August the Health and Social Care Secretary Matt Hancock announced an evidence-based review into the NHS Health Check service. Alongside suggestions that checks are personalised in future, the review will consider ‘increasing the range of advice the checks can offer – for example, prevention of musculoskeletal problems’. This is a brilliant opportunity to make sure that people are routinely asked about the health of their muscles, bones and joints at 40 years of age, and are provided with advice to support their musculoskeletal health.

Policy colleagues at Versus Arthritis will be working to develop the case for including musculoskeletal conditions in the NHS health check. If ARMA members have evidence to contribute, or would like to know more please contact policy@versusarthritis.org.

by Laura Boothman, Senior Policy Manager, Versus Arthritis

The Government is inviting views on how we can live longer, healthier lives. There are some positive proposals for people with arthritis – but Versus Arthritis will continue to demand more action to help people look after their musculoskeletal health. 

In 2018, the Government set a mission to ensure that by 2035, people can enjoy at least five extra healthy, independent years of life and to narrow the gap between the richest and poorest in the country. On 22 July 2019, ‘Advancing our health: prevention in the 2020s’ was released. This official green paper sets out the Government’s suggestions to tackle preventable ill health and invites people to give their views. So what does this mean for people with arthritis? 

Recognition of the impact of arthritis

The green paper highlights that, for the last 30 years, musculoskeletal conditions that cause problems with joints, bones and muscles have been the most common reason for years lived with disability in England. We know that too often arthritis is simply dismissed or overlooked, so this recognition by Government is important. However, we were also expecting concrete actions that would make a real difference and help people to look after their musculoskeletal health.

Action to tackle musculoskeletal conditions in workplaces

We know that people with arthritis often want to work but can find this difficult. That’s why Versus Arthritis is actively campaigning so that people have better support to be in work. VA welcomes proposals in the paper that the Government will bring together experts to review guidance for employers, develop a package of tools for employers to use to support their employees, and how these can be better promoted and used. These ideas, alongside proposals to address job loss due to ill-health are a start, though more needs to be done to put suggestions into practice and to build understanding of the impact arthritis has on people’s working lives.

Other areas for action

Several other proposals are promising for people with arthritis, including:

  • A call for evidence on musculoskeletal conditions, including priority areas for action such as awareness raising, physical activity, behaviour change programmes and links between mental and musculoskeletal health. Government is also interested in what data should be routinely collected about musculoskeletal conditions;
  • A digital design challenge for strength and balance exercises, focused on people with health conditions;
  • Work with charities and Sport England on a new physical activity campaign; and
  • A ‘Home of 2030’ design competition to explore how more energy efficient, accessible and adaptable homes can be designed.

What happens next?

The consultation runs until mid-October and Versus Arthritis’ policy and public affairs team will be working to ensure that views of people with arthritis are heard by Government through this process. VA does not accept that these proposals are enough and will demand more to tackle the pain, fatigue and isolation that arthritis causes. Add your voice and campaign with Versus Arthritis.

NASS logoby Jill Hamilton, Professional Engagement Manager, National Ankylosing Spondylitis Society

On 22 July 2019, the government quietly published their green paper Advancing our health: prevention in the 2020s. There has been a lot of commentary in the media, although it has been hugely overshadowed by activity in Westminster and the appointment of a new Prime Minister.

What is a green paper?

A green paper is a consultation document. This means that this isn’t the final version and so people both inside and outside parliament are able to comment on policies being proposed.

Relevance axial SpA (AS)

Many people may read the title of the paper and think to themselves ‘this has nothing to do with AS, you can’t prevent it from happening’, and they would be right about axial SpA (AS) not being preventable, but not that this paper has nothing to do with people living with the condition.

Musculoskeletal (MSK) conditions are problems with bones, joints and muscles, and axial SpA falls into this broad category. MSK conditions are mentioned a significant amount in the paper, particularly when it comes to the amount of disability caused by MSK conditions. Axial SpA (AS) is not specifically mentioned.

There are many areas of the paper which can be directly applied to axial SpA (AS), including a very heavy emphasis on physical activity, mental health, access to work and social prescribing.

The paper is also asking for evidence on musculoskeletal conditions including:

  • raising awareness of MSK conditions among the public
  • the role of physical activity
  • population-level behaviour change programmes
  • action to support staff in the workplace
  • links between mental and MSK health
  • What data should be routinely collected on MSK conditions

 

Is it slightly disappointing that awareness of MSK conditions amongst health professionals is not a focus, as is the lack of recognition of the role of the voluntary sector, which NASS will include in their response. You can read the open letter from National Voices members, including NASS, which was published in The Guardian a few weeks ago in anticipation of this paper being published.

NASS plan of action

The consultation is running from now until 22 October. During this time, NASS will put together a comprehensive response to the paper, ensuring that people with axial SpA (AS) and the Medical Advisory Board are consulted on their views before the submission of a final version. The response from NASS will be very specific to the AS community. NASS will also work with the Arthritis and Musculoskeletal Alliance (ARMA) on a joint response from the whole MSK community which will be more general.

APPG for Axial SpA

The All-Party Parliamentary Group for Axial Spondyloarthritis will also be working to prepare a response to the consultation, led by NASS and will look to ask parliamentary questions on the paper when parliament reconvenes in the autumn.

This new resource looks at how Allied Health Professionals can be involved with social prescribing, not just AHPs who work in the NHS but also those in private practice. The framework sets out four ways AHPs can engage with social prescribing, from active signposting, to involvement in the development of social prescribing and gives examples of how different AHPs might do this.

Social prescribing improves outcomes for people by giving more choice and control over their lives. It is effective at targeting the causes of health inequalities and is particularly useful for people who need more support with their mental health, have one or more long-term conditions, are lonely or isolated, and/or have complex social needs that affect their wellbeing.

The framework includes a range of AHPs, including those who are ARMA members such as physiotherapists, dieticians, osteopaths, and occupational therapists. It explains why AHPs should be interested in social prescribing and how to approach the different roles they might play:

  • Active signposting
  • Refer to a link worker
  • AHP as prescriber
  • AHPs promoting, growing and developing social prescribing

 

The framework is accompanied by a policy report giving recommendations for AHPs and for system leaders to ensure the maximum benefit from what AHPs have to offer.

All AHPs:

  • To continue to embed holistic care into their roles and to use social prescribing as part of this.
  • To connect with their local link workers to build a picture of social prescribing opportunities applicable for their users.
  • To champion social prescribing and share good practice examples.

 

AHP leaders and managers:

  • To connect with their local system to articulate how AHPs can support social prescribing, whether that is through provision of services, pathways development, training, supervision or advice.
  • To champion social prescribing as part of effective service delivery.

 

System leaders:

  • To draw on the skills and expertise of AHPs as they develop pathways, support and quality assurance frameworks around social prescribing.
  • To explore opportunities to develop directories of services, through applications such as MECC to support active signposting by a range of professionals.