Clinical Networks: Frequently Asked Questions

This page aims to answer some Frequently Asked Questions about ARMA’s project to support the development of MSK clinical networks in England, in partnership with the National Clinical Director for MSK. Since 2015, ARMA is working in close partnership with NHS England to deliver this project. The NHS Confederation is also supporting the project through the production of a Resource Pack for the establishment of effective MSK clinical networks.

The project has been a priority for ARMA since April 2013. It follows a “top-down” and “bottom-up” approach, and has the twin objectives of bringing knowledge together and bringing people together.

Insofar as this project is a long-term project of organic development, this FAQ document may evolve as the project evolves.

Why networks?

Although networks have a key role to play in all health care, the multii-faceted and complex nature of MSK – many professions, diverse patients, and over 200 conditions – means that designing and delivering sustainable service improvements necessarily involves ensuring the inclusion of diverse MSK professions, practitioners and patients. Networks play differing roles in healthcare. Some networks design and implement change across organisations, while others more informally simply link individuals with common interests.

The Health Foundation argues that networks are ideally placed to tackle systemic and complex problems faced by commissioners, providers and regulators, as well as frontline staff and service users. Research has suggested that networks contribute to healthcare improvement by providing a forum for experimentation and creating knowledge, exchanging information and spreading good practice. Clinical networks can take many forms, ranging from informal groups to more structured associations and serve a number of functions. The Health Foundation highlighted that effective networks were characterised by the “5 Cs”:

  • common purpose
  • cooperative structure
  • critical mass
  • collective intelligence
  • community building

 

What is a musculoskeletal (MSK) clinical network?

When ARMA refers to MSK clinical networks, we mean a network

  • at “local” (eg CCG) or “regional” (eg LAT/SCN/Clinical Senate) level
  • with an explicit focus on MSK, characterised by –
  • a workplan which addresses each of the 5 key priority areas;
  • at least one person from each of the “MSK 9” group. Involvement of each of these might take different forms in different networks (eg from direct active involvement, to informal consultation and communication); the key point is to ensure that all the relevant MSK groups are constructively involved in work to improve services for people with MSK conditions.

This is not exclusive, and networks may and arguably should also focus on issues that are specific to their areas. Everything else is variable. ARMA cannot, nor wishes to be, prescriptive about the specific arrangements around each network, as it is critical that each network develops in response to, and remains flexible around, current national, regional and local conditions, priorities and service provision. Some networks already exist which include most, if not all, of the above. Where there are gaps, eg in terms of membership, the MSK network should actively seek to address that gap.

 

What will the networks do?

The overarching and ultimate goal of MSK networks is to improve care for all people with MSK disorders. In a broad sense, MSK networks specifically exist for two primary reasons: bringing knowledge together, and bringing people together. All networks will develop their own workplans, addressing each of the identified 5 priority areas, adding to these as necessary in response to local or regional need. They will help to ensure local networks benefit from and are informed by work carried out by national working groups, and will also work to ensure learning is shared across CCGs in their region.

“Local” (CCG or consortia of CCGs) MSK networks will be primarily concerned with instigating, maintaining and reviewing/ monitoring local service developments and ensuring that there are integrated community services, effective FLS services, appropriate education and training and that these are underpinned by effective patient involvement and the use of effective and easy to use outcome measures to assess progress against identified objectives.

 

Who do MSK networks need to involve?

We have captured the wide range of people who should be part of any MSK network in asset of 9 broad categories – the “MSK 9”. Local and regional MSK networks should seek to involve at least one person from each of these groups in their network. The various groups may be progressively filled, but those in bold are broadly seen as being particularly important to involve in getting an MSK clinical network off the ground.

The “MSK 9”

1. Patients
2. Care co-ordinators (the “Care and Support Partner”)
3. Primary care, inc: GPs, practice nurses
4. Allied Health Professionals, inc: physiotherapists, chiropractors, osteopaths, occupational therapists, podiatrists, specialist nurses
5. Community care, inc:  MSK doctors, community matrons, pharmacists
6. Consultants, inc: rheumatology, orthopaedics, pain medicine
7. Public health practitioners
8. NHS management inc: CCG commissioners
9. Local Health & Well-being Board representative

These individuals may be formally involved with either a patient or professional organisation, but they must have relevant expertise, be based in the area in question and have the required capacity and commitment to dedicate to the MSK network.  

 

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What are the 5 priority areas?

These are the 5 key areas which have emerged as priorities, after extensive consultation with the MSK community from 2013-2014. These are the priorities which every MSK clinical network needs to address, in addition to any specific priorities which it may have identified in its locality or region. They are:

  • Promoting integrated, community-based MSK care and services
  • Workforce (education and training)
  • Fragility fracture liaison services
  • Patient involvement
  • Metrics/ outcome measures

The last two in particular, while representing distinct areas of focus, need to also underpin the other three priority areas, all of which need to actively factor patient involvement and outcome measures into their work.  

 

How are the National Working Groups (NWGs) going to support local and regional MSK clinical networks?

There is a National Working Group of multidisciplinary experts focusing on each of the 5 priority areas, except for patient involvement, which needs to underpin and form part of each of the NWGs. These 4 NWGs will provide expert guidance in each of their areas to the regional and local networks, and provide a reference point in their respective area for the various (or emerging) local and regional MSK networks. The 4 NWGs will also broadly take guidance from, and feed back to, NHS England via the MSK National Clinical Director (NCD).  

 

What is the geographical area for this project?

The ARMA project is limited to the NHS in England.  

 

Is there a statutory Strategic Clinical Network for MSK?

No. MSK is not currently one of the 4 centrally-resourced SCN areas. We hope however that this will change in the near future. In the meantime, we’re building MSK clinical networks from the ground up.  

 

Will ARMA provide advice to CCGs on MSK service specifications or competitive tenders?

No. ARMA has not and will not provide advice to CCGs on either service specifications or specific competitive tenders.

 

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Who is ARMA working with on this project?

Since April 2013, the project has had the active input and involvement of NHS England’s National Clinical Director for MSK. Since April 2015, ARMA has also been working closely with the Long-Term Conditions Programme team at NHS England, which is also providing project management support, through a formal partnership.

The NHS Confederation is also producing a Resource Pack based on the project to date, as a practical guide for the development of MSK clinical networks. The project has been continuously informed by and inclusive of the ARMA membership, including clinician and patient organisations and experts.

 

Are there any MSK clinical networks already functioning?

There are already a number of CCGs and Vanguard sites which are adopting a networks approach to improving MSK care, though they all differ slightly according to their respective local realities and arrangements.

There are also an increasing number of CCGs which have identified MSK as a priority and are engaged in MSK pathway redesign. Many of these are also actively setting up networks. It is intended that peer-to-peer support between “frontrunner” and other CCGs will be mutually beneficial and provide learning opportunities for both parties.

A number of ARMA member organisations also have a presence around the country which can link in to existing or developing MSK clinical networks.

Anyone who would like to share information with others and find out more about who is already doing what in MSK in England is invited to join the MSK Knowledge Network.

 

How will you share learning?

A core function of the 4 NWGs and the MSK Knowledge Network is to share knowledge and learning to improve MSK care between key stakeholders and across disciplines and “levels” of involvement.

Key resources and information about the project will also be made publicly available through various channels, including the ARMA website, the NHS Confederation website and the NHS England website.

There will also be opportunities to participate in seminars and learning events throughout the course of the project. To find out more, please MSK Knowledge Network.

 

I’d like to set up an MSK clinical network in my CCG. How should I go about this?

There are a number of key resources which are available to anyone wishing to set up an MSK clinical network in their locality where one is not already present: please visit our Key Resources page.

Most successful system redesign, not limited to MSK, has displayed the following key traits:

  1. A clear vision of how care needs to be reformed to deliver improved outcomes
  2. Building flexibility into the system, ie breaking down silos and not being unduly constrained by rigid processes, levers or mechanisms.
  3. Perseverance: lasting change takes time

 

Other key factors highlighted by successful innovators included:

  • Ensuring that MSK needs were written into the Joint Strategic Needs Assessment (JSNA) – see an example from Ealing.
  • Involving patients effectively and consistently to identify what’s working and what is needed
  • Bringing together all involved (the MSK 9) to create fully informed and supported service re-design, allowing sufficient time to build trust and relationships.
  • awareness of change management theory and practice by innovators
  • Using peer-to-peer influence to encourage best practice and collaboration and reduce opposition
  • Appropriate education, especially of primary care practitioners, integral to provision of improved services
  • Gain motivation by focusing on improved patient outcomes as a result of service improvements, rather than simple cost-reduction
  • Patience – forming networks and productive relationships takes time – sustainable change takes time to initiate and deliver, but the outcomes are better and sustained in comparison with those who tendered out services without groundwork, which then tended to fail
  • Data and outcomes – keep outcomes data simple, clear and realistic.

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