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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: NHS Long Term Plan

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.

NASP logoOctober saw the launch of a new National Academy for Social Prescribing (NASP), to champion social prescribing and the work of local communities in connecting people for wellbeing. Its objectives include exploring new ways of sourcing statutory and non-statutory funding and brokering relationships between different sectors. Given the prevalence of MSK conditions, it is important that social prescribing has something to offer for MSK.

The NHS Long Term Plan includes plans to recruit over 1,000 trained social prescribing link workers by 2020 to 2021, with the aim of 900,000 people being referred to social prescribing schemes by then. In some parts of the country, patients with long-term conditions who have had access to social prescribing link workers have said they are less isolated, attended 47% fewer hospital appointments and made 38% fewer visits to A&E.

The Chair of the NASP is Helen Stokes-Lampard, who as a GP will be all too aware of the importance of MSK conditions to the NHS. ARMA will be working to raise MSK so that link workers understand the importance of MSK and the types of community support, including peer support from patient groups, which can help.

More information on the NASP website.

Guest blog by Amanda Woolley, Policy and Implementation Lead for the Elective Care Transformation Programme at NHS England and NHS Improvement

The NHS Long Term Plan set the ambition to reduce outpatient attendances by a third over the next five years. Rheumatology services are leading the way in developing alternatives to the traditional outpatient model so that patients can access the support and treatment they need, at the time they need it.

Most people seen by rheumatology services will have chronic, long term conditions, such as rheumatoid arthritis and will require continuing specialist input to support management of their condition. In fact, rheumatology sees more follow-up attendances for each new first attendance than any other high-volume specialty after oncology and haematology.

However, the traditional outpatient model of routinely scheduled appointments at three, six or twelve month intervals rarely provides an optimal level of care for these patients. With a routine appointment, patients have to attend hospital even if their symptoms are currently well managed. This can be inconvenient and costly for the patient and is an inefficient use of NHS resources. Conversely, patients are not always able to get the support and treatment they need at the time they need it when their condition worsens.

Unsurprisingly then, rheumatology services are paving the way for transforming how to deliver ongoing specialist care for those with long term conditions. New approaches to outpatient delivery established in rheumatology settings include patient-initiated follow-ups, telephone clinics, use of remote monitoring apps, and better education programmes to support self-management. In addition, rheumatology services have taken the opportunity of using specialist allied health professionals, nursing staff and pharmacists to ensure timely access to the right support for managing different aspects of these chronic conditions.

While there are numerous examples of innovative practice, these approaches are not universally implemented across England. The challenge over the next five years is to learn from what has already been achieved and spread this to all areas of the country, both in other rheumatology services and across other specialties.

The Elective Care Transformation Programme supports local health care providers and commissioners to make sure that patients requiring a specialist opinion or treatment see the right person, in the right place, first time and every time. We are delighted to partner with ARMA in hosting the Rheumatology follow-ups: Transforming Outpatients webinar to share the learning of what is already in place and discuss the barriers to further implementation across rheumatology and beyond.

Anyone involved in redesign of outpatient and elective care services is welcome to join our online community of practice where they will find information and guidance for outpatient transformation across 14 high volume specialties and numerous potential interventions and ideas for service redesign. The community of practice also hosts online discussion forums and regular webinars where members can ask questions and share ideas.

To join the elective care transformation community of practice, email ECDC-manager@future.nhs.uk.

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 Michael Ly, Health Intelligence Manager, Versus Arthritis

In January 2019, NHS England published the NHS Long Term Plan, outlining its vision to improve the health and wellbeing of people over the next 10 years. Central to this vision is a commitment to designing and delivering services that are more joined-up, tailored and community-based to meet the needs of local people, including those who face health inequalities.

To do this effectively, the Long Term Plan recognises that local health and care systems will need to work in partnership with communities and charities to understand the health and care needs of their local population.

To support this, members of the Health and Wellbeing Alliance, together with Healthwatch and Versus Arthritis, have produced Health and Wellbeing Resources Packs for local health and care systems in England.

The Resources Pack brings together a range of information and data to build a shared understanding about the local population and the communities in which they live, the wider local context affecting health and wellbeing, and specific aspects related to the delivery of local health and care services. This includes existing information from national sources, along with other data about the voluntary sector, local people’s views, and wider social factors affecting health and wellbeing that is perhaps less well known.

It is intended for all those working in and with local health and care systems in England, including those working for the NHS or other public sector services, charities, social enterprises, or special interest and community groups.

Resources Packs have been produced for the 42 STPs and ICSs in England in July 2019.

Read more from the Age UK website.

 

Rheumatoid Arthritis (RA) is very much on my mind as I write this during RA Awareness Week. Yesterday I attended a roundtable discussing the NHS Long Term Plan (LTP) and RA. Rheumatology doesn’t get a specific mention in the plan, but there is plenty of content on related issues. There is mention of chronic pain, for instance, which is very relevant to ARMA and to RA. Access to integrated pain services is something ARMA members have identified as a priority following the publication of our mental health report last month, and by the time this is published I will have presented at a meeting of the Chronic Pain Policy Coalition.

MSK gets a number of mentions in the Long Term Plan but it’s easy to get the impression that this is all about osteoarthritis. ARMA is very clear that rheumatology is part of MSK, and just as important a part of our work as orthopaedics. I am part of an advisory group for the NHSE review of elective care access standards (waiting times in plain English) and I know that this is a vital issue for rheumatology. There are delays in patients recognising that their symptoms might be serious, and often further delays in GPs making a referral to rheumatology so, once referred, it’s vital that there isn’t a long wait to see a rheumatologist. But the roundtable heard that only 32% of RA patients are seen in a time recommended by NICE and almost 10% wait longer than the general waiting time target of 18 weeks.

The roundtable heard that three things impact on remission rates for RA and one of them is rapid access to specialist assessment.  Another is starting therapies quickly. The Long Term Plan talks about reducing delays in access to evidence based treatment. The example it gives is joint replacement surgery, but access to biologics in RA is another excellent example.

The final factor increasing chances of remission is a person centred holistic approach to care. The roundtable heard about unmet needs of RA patients, including pain, anxiety and depression. ARMA’s roundtable report on mental health and MSK has been well received in both MSK and mental health sectors. It’s very relevant to RA patients, and we will be pursuing the recommendations over the coming months.

After the meeting I was asked what would help rheumatology get the best out of the Long Term Plan. Part of my answer was that it needs to be clearly part of MSK, which is included in the plan. Which is why ARMA’s core offer for local NHS Plans includes rheumatology. Let’s be clear, no CCG, STP or ICS can say it is delivering good MSK services if it hasn’t included rheumatology, pain and mental health in their plans.

One major criticism of the NHS Long Term Plan was the lack of any detail on workforce. This detail has begun to emerge with the publication of the Interim People Plan for the NHS. It looks at the need to transform the way the entire workforce, including doctors, nurses, allied health professionals (AHPs), pharmacists, healthcare scientists, dentists, non-clinical professions, social workers in the NHS, commissioners, non-executives and volunteers, work together. It works on the basis that multi-professional clinical teams will be the foundation of the future workforce, rather than treating the workforce as a group of separate professions.

This new multi-professional way of working will be essential for MSK services, where there are high levels of multimorbidity and good person-centred care is rarely the responsibility of one professional.

The plan has 5 themes:

  • Making the NHS the best place to work
  • Improving the leadership culture
  • Tackling the nursing challenge
  • Delivering 21st century care
  • A new operating model for workforce

A full, costed five-year People Plan will be developed later this which will build on the vision and actions in this interim Plan. This will set out in more detail the changes to multi-professional education and training, career paths, skill mix and ways of working needed and quantify in more detail the full range of additional staff needed for each of the NHS Long Term Plan service priorities.

There are accompanying documents setting out the vision for the future workforce for allied health professionals and psychological professions; dental; healthcare science; medical; and pharmacy.

The Institute for Voluntary Action Research (IVAR) has developed free support resources for health, care and voluntary sector leaders who want to drive action through partnership working around the NHS Long Term Plan. The resources include online learning, webinars, workshops, coaching and individual support and are aimed at ICS/STP leads, commissioners, clinicians, and professionals from the voluntary sector.

The NHS Long Term Plan commits local healthcare systems to working in a new way, including a focus on prevention and reducing health inequalities. Building relationships – with other health agencies, local government, providers and communities – will be essential for the leaders charged with bringing this ambitious vision to life.

The NHS Long Term Plan recognised the role Voluntary, Community and Social Enterprise (VCSE) organisations could play, in partnership with the NHS, to help deliver its vision. At a strategic level, NHS England is committed to working with VCSEs and establishing models for more equitable partnerships and better integration, and to increase the influence of the voice of patients. More locally, STP’s/ICS’s, as with any relatively new player in a system, are taking time to build consistently high and constructive levels of engagement with VCSE organisations and communities more widely. 

The Building Health Partnerships programme and this wider support offer – Transforming Healthcare Together – have been designed in response to all these challenges, to work intensively with statutory services to test and pilot new approaches to partnership working, and to support the leaders working to bring the NHS Long Term Plan to life.

The free support offer is for health, care and VCSE leaders who want to drive action through partnership working. There is a range of support for different levels, whether you are just getting started or have been working in this way for some time.