Guest blog by William Pett – Senior Policy Advisor, NHS Confederation

As people grow older, health conditions often become both more complex and chronic. Evidence shows that rates of those living with multimorbidity rise significantly with age; a recent study revealed that 30% of adults aged 45 to 64 years report at least two chronic conditions, increasing to 65% of adults aged 65 to 84 years and more than 80% for those above 85 years old.

For older people living with multimorbidity, musculoskeletal conditions are common. Organisations such as Versus Arthritis have drawn attention to this in recent years, highlighting that among those over 45 who report living with a major long-term condition, more than 3 out of 10 also have a musculoskeletal condition.

Yet, as those who have lived with comorbidities may tell you, the NHS has not historically dealt well with patients with multiple conditions. The health system has traditionally been focused around episodic care – one provider contracted to treat for one condition, another contracted to treat for a second condition. This in turn has made care pathways somewhat arduous for patients, requiring them to go to different locations for different conditions – especially problematic, of course, if you are older and less mobile.

Fortunately, things are beginning to change. The NHS Long Term Plan, which builds on the principles of the Five Year Forward View, looks to break down silo working across the health system and sets out how integration of services will improve outcomes for patients. There are likely to be several beneficiaries of more integrated working – including not just patients but also clinicians and the tax-payer – but it may well be those with multiple conditions who benefit most.

For those with musculoskeletal conditions specifically, care pathways are being made easier and more direct for patients through direct access to First Contact Practitioners (FCPs). Recognising that musculoskeletal conditions account for 30% of GP consultations in England, FCPs will allow those with conditions such as arthritis to see a physiotherapist at a local surgery straight away, without the need to go through a GP.

More broadly, the old model of GPs referring patients out to different specialist and community services is being streamlined through Primary Care Networks (PCNs). These will bring together GP practices and community services in neighbourhoods across England, with the aim of achieving fully integrated community-based health care. A key feature of PCNs will be multidisciplinary teams, comprising a range of staff from pharmacists to district nurses to physiotherapists, as well as those from the social care and voluntary sectors. Someone living with multimorbidity will therefore be able to have a single comprehensive care plan that recognises the complexity of living with multiple conditions at community level.

We are, however, in the very early stages of the new integrated world. Clinical directors leading PCNs are still settling into roles that didn’t exist a year ago, within networks that didn’t exist a year ago. There are multiple expectations being placed on PCNs and many clinical directors are beginning to feel overwhelmed. This is where the NHS Confederation comes in. The Confederation has launched NHS Primary Care, which will act as the voice of PCNs as they develop and begin to deliver against new service specifications. Crucially, if the ambitions of the Long Term Plan are to be achieved – and if care is to improve for those living with comorbidities – then it is vital that new integrated care models are given the time and resources they need to succeed.

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