Last Friday, March 31st, NHS England published a significant document about the future of the NHS: Next Steps on the NHS Five Year Forward View. The original NHS five year forward view set out why and how the NHS should change to address three issues: the health gap, the quality gap and the financial sustainability gap. The next steps updates on progress and sets out future plans.

Musculoskeletal conditions account for a major part of the workload of the NHS, 40% of which is due to potentially preventable risk factors. The NHS spends £5 billion a year treating them. Yet they get surprisingly little focus in Next Steps, at least directly. Musculoskeletal includes everything related to bones, joints and muscles, from back pain to rheumatoid arthritis. The associated pain and mobility problems have a significant impact on people’s ability to work (and pay tax), and to contribute to family and community life. This impact is set to rise as we all live longer and healthcare demands will increase with us needing to remain mobile and independent.

The most significant reference to MSK is to hip and knee replacements, including recognising that waiting times for these operations may go up. Whilst Next Steps talks about the huge increase in hip replacements in the last 15 years, a recent report from the Kings Fund found that in the last year there are signs that the number of hip replacements is going down. Given the high level of evidence of the effectiveness of this operation and the needs of the population, this is travel in the wrong direction.

Whilst there are few other explicit mentions of MSK in the rest of the document, it is clear to me that MSK services have a big role to play in these plans for the future of the NHS. Priorities include integration of services, better access to primary care and prevention. There are many links between these and good musculoskeletal services.

ARMA, working in partnership with NHS England, recently organised a series of regional events, bringing together professionals from primary and secondary care with patients, to talk about local plans to improve musculoskeletal services. The discussions would have felt very familiar to the authors of Next Steps. Integration, partnerships, moving care into the community, how physiotherapists in GP surgeries can reduce pressure on GPs and so save money. One frustrated physiotherapist said “we’ve shown it works for patients and saves money. Why is this not being rolled out everywhere?” Yet the chapter on primary care talks about a wider range of staff without mentioning physiotherapy.

Ultimately what this document is about is financial sustainability – saving money. All the evidence is that there is wide scope for more effective use of resources in musculoskeletal services to deliver what patients want and need. As our events showed, the will is there in the MSK community – both patient groups and professionals. What is needed is for the NHS, both locally and the national improvement programmes, to embrace this and make sure it happens everywhere.

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