This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.
  • The Arthritis and Musculoskeletal Alliance (ARMA) is the umbrella body for the arthritis and musculoskeletal community in the UK, and our mission is to transform the quality of life of people with musculoskeletal conditions. We have 33 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Tag: multidisciplinary health

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.

ARMA joins Public Health England and the Centre for Ageing Better to make England the best place to grow old, because musculoskeletal health is vital to healthy ageing.

ARMA joined over sixty high-profile organisations in the UK’s health, housing, employment, research and voluntary sectors to launch a landmark shared vision on healthy ageing.

There are five key principles: prioritising prevention and public health; creating opportunities for people to contribute to society as they age; fostering accessible and inclusive homes and neighbourhoods so everyone can live where they want; narrowing inequalities in healthy ageing; and challenging ageist language, culture and practices.

This initiative is led by Public Health England (PHE) and the Centre for Ageing Better. We will work together with these and others because musculoskeletal health is vital to a good later life.

Find out more from the Ageing Better website.

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 Sue Brown, CEO ARMA

I write this reflecting on my day yesterday, which was unexpectedly dominated by discussions on pain. Pain is, of course, something we all talk about a fair bit in the MSK health world, as it’s one of the shared factors that cuts across all MSK conditions. I’m increasingly realising it is something we don’t always deal with particularly well.

My day yesterday began with reading New Scientist on the train, including an article about UK doctors’ concerns that we will follow the US into an opioid crisis. The question raised in the article was: is there a risk we will take things the other way, so that when someone does need opioids, they won’t be able to get them? The day ended at a wide-ranging lecture by Simon Stevens, Chief Executive of the NHS, including a slide showing opioid prescription rates by region: a wide variation, with London the lowest, and the North East the highest.

My discussions throughout the day all touched on pain in some way, but with a much broader agenda. Pain is rarely a simple matter which can be solved by pills alone. Yet that’s the only option offered to so many people. ARMA promotes a person-centred, integrated, biopsychosocial approach for anyone who experiences chronic pain. The prevalence of chronic pain is highest in the North East of England, and lowest in London (43.1% vs 29.0%). There is something going on here which is not just physical. We know that there are strong links between physical and mental health, which is why ARMA recently organised a roundtable on mental health. It is clear from my discussions yesterday that this is crucial in the context of chronic pain.

My issue with the debates about opioids is that they are about opioids. It seems to me that this is starting in the wrong place. The question is not what can we do about the increase in opioid prescription but what can we do about the increase in chronic pain? We need a much more sophisticated discussion. If pain is complex and individual, then the solutions must be personalised and multidisciplinary. We need to be able to refer people for psychological support. That might be IAPT psychological services for people with MSK pain. It might be health psychology in the context of a specialist pain service. We need to have appropriate peer support and social prescribing offers. We need to look at the underlying causes of pain and treat those where possible. The best pain services in the world are not useful if what the patient really needs is joint replacement surgery or rapid access to physiotherapy. And we need appropriate prescribing, and clinicians confident to discuss the different options and engage in good shared decision making with their patients.

This is not an issue which can be addressed by one profession. Patients in chronic pain may need GPs, rheumatologists, surgeons, pharmacists, psychologists, physiotherapists and others, working together. As with so much else in MSK healthcare at the moment, this support doesn’t join up and in the case of psychological support, too often isn’t available at all. This is why ARMA has made mental health a priority for this year. Together with our members, we will be pushing for improved access to joined-up, multidisciplinary personalised biopsychosocial support for people in chronic pain. We’ve already had some webinars on the subject, including how to deliver an integrated pain service and how to integrate mental health into physical health services. We’ve held a roundtable and produced our report. Look out for more activity including webinars and our annual lecture in November that push this agenda forward.

Join with us in calling for action to provide comprehensive services which address chronic pain from all angles. Patients with chronic pain deserve nothing less.