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  • 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: networks

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.

by Duleep Allirajah, Assistant Director of Policy and Campaigns, RCGP

As any patient who struggled to book a GP appointment will know only too well, general practice in the UK is under immense strain. Demand for appointments is rising and GPs are seeing more patients with complex needs. At the same time, practices are closing, workloads are reaching unsafe levels and burnt-out GPs are quitting the profession. That is why the Royal College of General Practitioners decided the time was right to publish Fit for the Future, our vision for the revitalisation of general practice.

If general practice is to survive and flourish, it needs a radical overhaul. Sticking plasters will not suffice. GPs must embrace multi-disciplinary team working and collaborate at scale with neighbouring practices. But, we don’t want an impersonal, industrial-scale service. Continuity and holistic care must remain at the heart of tomorrow’s general practice. At scale, yes, but with a personal touch.

We consulted extensively with GPs and patients in developing our vision. What I heard time and again was that consultations were too short – the average length in the UK is less than 10 minutes. It’s time to rethink the consultation so that it works better for GPs and their patients. Our ambition is for the standard consultation to be at least 15-minutes or longer where necessary. The method of consultation will also change. Patients will also be able to access their GP surgery by video, online or telephone consultation. The relationship between GP and patient will also be recast. In future, patients will be treated as equal partners in their own care, shared decision making will be the norm, and medication won’t be the default option.

General practice in the future won’t just be delivered by GPs. It will be very much a team endeavour. Care will be delivered by multi-professional practice teams comprising a range of clinical and non-clinical roles. One of those roles is the first-contact practitioner, who can assess, diagnose and provide initial treatment for patients with musculoskeletal conditions (MSK). An audit of a service in Forth Valley NHS found that first contact practitioners were able to deal with 99% of MSK patients in GP surgeries. Services like these mean no lengthy waits for MSK appointments; they also free up GPs to focus their skills to where they are most needed – diagnosing serious health conditions and managing multimorbidity.

Will the expansion of practice teams erode continuity of care which, as the evidence shows, leads to better health outcomes? It is a risk which requires us to find creative solutions. The College is currently supporting the Health Foundation to test out innovative approaches to continuity’ – for example using ‘micro-teams’ – which can preserve the benefits of relationship-based medicine as general practice moves to multidisciplinary team working.

In our vision, GPs won’t just be working with a wider range of practitioners in their surgeries, they will also collaborate with neighbouring practices to deliver placed-based care for their communities. Too often today, practices are forced to merge because they are no longer financially viable. We want to see GPs collaborate at scale freely, not because they are compelled to but because it is the right thing to do. Ideally, GPs will shape and feel real ownership of these new networks or federations. There are huge benefits to working at scale, such as pooling back office functions or clinical staff and moving more services from acute to primary care settings. Over time, these GP networks and clusters will become well-being hubs, hosting a range of well-being, healthy living and community services. This way general practice can play a proactive role in preventing ill-health, reducing health inequalities and building community resilience.

Realising our vision will depend on several key enablers – increased funding, workforce capacity and skills, a radical upgrade of GP premises, state-of-the-art digital technology and more GPs engaged in innovation and research. Ours is an ambitious vision but not a pipe dream. With these building blocks in place we can not only deliver world class, patient-centred primary care, we can ensure that being a GP can be the best job in the world.