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Tag: coronavirus-covid19

Joint statement from professionals and patients on MSK services in the event of a second wave of Covid-19

With cases of Covid-19 rising and the prospect of increased pressure on hospitals this winter as a result, it will be unacceptable for the NHS to respond to this by treating only urgent and emergency cases in musculoskeletal (MSK) services.

As organisations representing patients and professionals, we recognise that this was a necessary response in spring of this year. However, it came at significant cost to patients’ physical and mental health, and the resulting suffering will continue for many months, perhaps years, to come. People needing surgery such as joint replacement, people needing to see rheumatology specialists and people needing access to community MSK services were all hit hard in the effort to ensure that the NHS could respond to Covid-19 patients.

With the benefit of all the learning of the last six months, the NHS needs to ensure that pathways for MSK patients are kept open as much as possible. There have been many beneficial innovations in MSK services in response to the virus which will help maintain services. Services also need to make the maximum possible use of available resources to support self-management including patient support groups, such as our patient member organisations, who can help ease the pressure on the NHS. The government must act to ensure that the NHS has the testing service it needs, and steps are taken to manage infection rates, so that the NHS does not see the suspension of much of its core services.

Before the pandemic, many MSK services, and especially joint replacement waiting times, were falling well short of targets. This situation is now significantly worse with much longer waiting times, backlogs of missed appointments and concerns that people with serious conditions may not have yet been able to access diagnosis, still less treatment. In England as at the end of July, there were over 36,000 people were waiting more than 18 weeks for rheumatology treatment.  There were also over 320,000 people who have been on the waiting list for over 18 weeks for trauma and orthopaedic care, including joint replacement surgery. They are likely to be in considerable pain, with reducing mobility and experiencing deterioration of their overall physical and mental health.

“If my RA continues to worsen this may impact my chances of remission. Just prior to lockdown we were discussing changing my meds; that is off the table for the foreseeable.”
(Person living with Rheumatoid Arthritis)

Delays in treatments lead to much poorer outcomes, with a long-term impact on people’s ability to remain active and in employment and to manage their general health. Delays in diagnosing inflammatory and autoimmune conditions can lead to irreversible damage with long term impact on the individual and cost to the NHS of subsequent treatment. Delays in accessing joint replacement surgery result in worse outcomes and deterioration in general health and fitness.

“I feel I’ve been forgotten about. I have so many questions as I was diagnosed in February 2020, and it was while I wasn’t able to have a face-to-face appointment at the doctors, so he told me on the phone and wasn’t helpful at all. I’ve been told the diagnosis but with no info regarding what to do next – I desperately need advice on what next with medication or physio but I’m just waiting and waiting.”
(Person living with Axial Spondyloarthritis)

“I’m generally an upbeat person so I’ve been able to deal with it, but it’s becoming hard to keep going physically and mentally.”
(Person living with rheumatoid arthritis, osteoarthritis and asthma.)

Inability to access community MSK services leads to reduction in function and muscle strength and increased pain. These services are already under additional pressure due to post-Covid rehabilitation and the impact of lockdown on people’s MSK health. In this context, redeployment of significant numbers of community MSK staff to respond to a second wave is untenable.

MSK health, and therefore MSK services, are vital to people’s ability to live healthy and active lives. It would be unacceptable for MSK services to be expected to shut down, and people with MSK conditions to face the same inability to receive the treatment they need, a second time.

ARMA Members:

  • Arthritis Action
  • BackCare
  • British Association of Sport Rehabilitators and Trainers
  • British Chiropractic Association
  • British Dietetic Association
  • British Orthopaedic Association
  • British Society of Rehabilitation Medicine
  • Chartered Society of Physiotherapy
  • College of Podiatry
  • Ehlers-Danlos Support UK
  • Faculty of Sport and Exercise Medicine
  • Fibromyalgia Action UK
  • Hypermobility Syndrome Association
  • The Institute of Osteopathy
  • Musculoskeletal Association of Chartered Physiotherapists
  • National Axial Spondyloarthritis Society
  • National Rheumatoid Arthritis Society & JIA
  • Podiatry Rheumatic Care Association
  • PolyMyalgia Rheumatica and Giant Cell Arteritis UK
  • Primary Care Rheumatology Musculoskeletal Medicine Society
  • Psoriasis Association
  • Rheumatology Pharmacists UK
  • Royal College of Chiropractors
  • RCN – Rheumatology Forum
  • Scleroderma & Raynaud’s UK
  • Society of Musculoskeletal Medicine
  • Society of Sports Therapists
  • UK Gout Society
  • Versus Arthritis

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With cases of COVID-19 currently rising across the UK, there are discussions of a second wave resulting in a spike in COVID-19 -related hospital admissions this autumn. In the first wave many of the activities of the NHS were put on hold as a precaution to preserve capacity. This was understandable in the face of a rapidly escalating and unpredictable threat. However, the BOA is keen to help ensure that in the event of a second wave the normal care of our patients is only suspended as a consequence of absolute necessity.

You can read the full statement on the BOA website.

In July and August 2020, NRAS ran a survey asking about the impact of the Covid-19 lockdown on the working lives of people living with rheumatoid arthritis or another form of inflammatory arthritis.

The survey received 348 responses and a short report will be published next month. The overall picture is a concerning one: people reported that their career opportunities, in-work support and the understanding they experienced from colleagues and employers dropped slightly during lockdown. Asked about their expectations for the future, many expected this trend to get worse.

The survey brought up positives as well: most respondents spoke of getting appropriate support and that most employers and colleagues were understanding. Many reported more flexibility from their employers – 66% were supportive or very supportive of those shielding; a further 23% were ‘only as supportive as necessary’.

The NRAS report will go into all this in more detail, but it is already clear that we must encourage employers to support staff with long-term conditions, highlight the resources and support available to them to do so, and highlight examples of good practice.

The Patients Association has published a report of patient experiences of Covid-19. The results show the massive toll on all patients of the coronavirus pandemic and the emergency measures taken in response to it. Some patients reported good ongoing care, and were impressed by the way their local communities came together to support them.

The report contains recommendations for the next phase of the emergency response, and also a call for the health and care system to be built back better after the pandemic: the current emergency footing cannot be the basis for the ongoing relationship between patients and the NHS.

The report proposes a number of principles for ensuring everyone has the best possible experience including:

  • Recognise that the impact of the crisis will fall hardest on those who already face discrimination and inequality
  • Maintain the principles and values of patient choice, shared decision making and voice,
  • Ensure there are fully resourced services available to help people maintain people’s mental wellbeing,
  • Provide clear, concise and timely communication, updated regularly.

Read the report in full.


The British Orthopaedic Association has published their latest patient statement for those people currently awaiting elective surgery, many of whom are experiencing uncertainties and difficulties. Growing waiting lists are affecting all planned surgery, but particularly orthopaedics (bone and joint treatment) which has the largest overall waiting list of any individual specialty.

The BOA has created this statement to provide some information and guidance to support patients during this time. If you could please pass this on to help reach those affected it would be most appreciated.

The statement is available at:


For some time now NRAS and their Health Professional Medical Advisor in this field, Dr. Kanta Kumar, (Lecturer at the University of Birmingham), have wanted to be able to provide a tailored service and support for the UK South Asian population. One of NRAS’s long term strategic aims is to make our services more visible, relevant and accessible to those who need them most, particularly those communities who, for reasons of language, culture and/or health literacy skills may be less able to negotiate about their healthcare needs or successfully navigate the health system.

The Apni Jung (‘Our fight’ against RA) project launched in 2016 and since then NRAS has been adding to their resources on the Apni Jung area in Hindi and other Indian languages. The most recent addition to the website is a video Q&A in Hindi with Dr. Kumar and Consultant Rheumatologist from Oxford, Dr. Shirish Dubey, to help members of the UK’s Asian community keep themselves and their families safe from COVID-19.

So that health professionals know what the video is covering, it asks the following questions:

  1. What is COVID-19 and symptoms?
  2. If I am experiencing symptoms of COVID-19 what should I do?
  3. What if I am fully well – what should I do?
  4. What if no one is around to help me – what should I do?

The virus is still very much with us and some of the areas where infections are currently increasing include South Asian communities, so please do share the link to this video with your South Asian patients:

For more information about our Apni Jung work, please contact

After more than four months shielding, NRAS founder and National Patient Champion Ailsa Bosworth MBE has shared her thoughts on shielding coming to an end.

You can watch Ailsa’s video of her personal reflections on the lockdown experience and coming out of shielding on the NRAS YouTube channel.

The Institute of Osteopathy has issued an information video about what patients can expect when visiting an osteopath during COVID-19.

The video highlights the steps the osteopathic profession have taken to ensure patients can be confident that steps have been taken to keep them COVID safe.