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Topic on a Page - MSK Conditions

Data Sources:

Public Health England Musculoskeletal Diseases Profile

Arthritis Research UK:

Musculoskeletal Calculator

Supporting Information:

NICE:

NICE: Osteoarthritis overview

NICE: Low back pain

NICE: Musculoskeletal conditions and other

NHS Evidence:

Musculoskeletal

Musculoskeletal Mobility

Musculoskeletal Pain

Musculoskeletal Management

Musculoskeletal Disability

Neck Pain

Neck Injury

Neck Conditions

Lower Back Pain

Osteoarthritis

Shoulder

NHS England:

Musculoskeletal conditions

Transforming musculoskeletal and orthopaedic elective care services

NHS Rightcare Musculoskeletal National Priority Initiative – Back Pain

PHE:

Productive healthy ageing and musculoskeletal (MSK) health

Department of Health:

The Musculoskeletal Services Framework

Arthritis Research UK:

Musculoskeletal conditions and multimorbidities report

Osteoarthritis

Musculoskeletal Health, a public health approach

World Health Organization (WHO):

Reducing the global burden of musculoskeletal conditions

Arthritis and Musculoskeletal Alliance:

Policy Paper: Prevention of Musculoskeletal Conditions

Chartered Society of Physiotherapy:

Conditions

Patient UK:

Lower Back Pain

Neck Pain

Osteoarthritis

Health and Safety Executive:

Musculoskeletal Disorders

Linked Topics:

New Topic (Feb-19)

JSNA Topic: Musculoskeletal (MSK) Conditions

Background

Musculoskeletal (MSK) conditions are a group of conditions that affect the bones, joints, muscles and spine, and are a common cause of severe long term pain and physical disability. There are 3 groups of MSK conditions:

  • inflammatory conditions, for example, rheumatoid arthritis
  • conditions of MSK pain, for example, osteoarthritis, back pain and gout
  • osteoporosis and fragility fractures, for example, fracture after a fall at standing height.

MSK disorders comprise a heterogeneous collection of more than 200 separate conditions. Common symptoms include pain, stiffness and a loss of mobility and dexterity.

This chapter will focus on the leading and most common causes of MSK morbidity and mortality; low back and neck pain as well as osteoarthritis, it will not include Osteoporosis as this condition and its associated pathway will be included in the Lincolnshire STP Rheumatology review.

Nationally an estimated 17.8 million people live with an MSK condition in the UK that is around 28.9% of the total population. (Source: State of Musculoskeletal Health 2018 | Arthritis Research UK)

Each year one in five of the general population consults a GP about a MSK problem. (Source: Department of Health, 2011) MSK disorders are the third-largest condition of all causes of Disability Adjusted Life Years (DALYs).

MSK conditions cost the economy 10.8 million lost working days and £4.76 billion of NHS spending each year (NHS England, 2018).

Whilst life expectancy has risen, many people are living longer in poorer health - particularly those in more deprived parts of the country. The older a person is, the more likely they are to experience chronic diseases and disabilities such as poor MSK health.

There are multiple risk factors that can increase a person's susceptibility to MSK problems - these include physical inactivity, being overweight or obese, diets deficient in vitamin D or calcium, smoking, older age and genetic predisposition to some MSK conditions.

The number of adults registered in Lincolnshire reported to have an MSK condition, either long term back pain or long term joint pain, means proportionately that Lincolnshire has a significantly higher incidence rate than the East Midlands and England of reported MSK problems.

Long term pain relating to MSK conditions, particularly lower back pain, is an on-going issue that affects 10.4% of Lincolnshire's population; this level of prevalence is the highest in the East Midlands. Lincolnshire East CCG has the highest proportion of patients (11.7% of the population) suffering from long term pain in the county.

Context

National Strategies, Policies & Guidance

The National Institute for Health and Care Excellence (NICE) provides pathway support and background information on various MSK conditions, this support can then be linked to policy summaries relating to clinical interventions.
Musculoskeletal conditions - NICE Pathways

In June 2014, The World Health Organisation commissioned a Global Burden of Disease study for MSK conditions; this report highlights the worldwide impact of MSK conditions and calls for an Action plan for Europe.
Musculoskeletal disorders and the Global Burden of Disease study.

NHS England has developed several programmes to support the various work streams within the MSK pathway:

NHS England: High Impact Interventions MSK Triage.
This programme looks to support and identify good evidence based practice, collated into simple service specifications that can be used across various MSK settings including primary and secondary care. NHS England » High Impact Intervention

These high impact interventions are linked to and supported by the NHS RightCare programme. This programme highlights opportunities for quality and service improvement identified across all CCGs. NHS RightCare

NHS England Improving access to Psychological Therapies (IAPT) increasing access for Chronic Pain, supports the NHS request that all CCGs from April 2018 should improve access to Psychological Therapies by commissioning (IAPT) services integrated into physical healthcare pathways. The document supports this requirement by setting out the treatment pathway that underpins the access and waiting time standards, which all services should seek to measure themselves against. NHS England » The Improving Access to Psychological Therapies (IAPT).

NHS England » NHS Long Term Plan January 2019:
One of the key messages states that the populations’ MSK needs are not being met. Most MSK needs should be met within primary care, without the need for referral for secondary care services. Recommendations include:

  • First Contact Physiotherapists (FCP) need to be available to patients from all GP surgeries. The learning from the current NHS England FCP High Impact Intervention programme should be used to ensure full implementation can be delivered as part of the NHS Long Term Plan.
  • There is also recognition that MSK conditions are a big cause of sickness absence and that rapid access to treatment is important in reducing this.
  • The plan also includes a commitment to expanding the IAPT programme to people with long term conditions.

Local Strategies & Plans

The Lincolnshire five year Sustainability and Transformation Plan (STP) for local health service funding requires health providers to deliver services that meet the needs of local populations as well as supporting the Five Year Forward View vision and the NHS Long Term Plan, which includes a ‘radical upgrade’ clinical pathways and prevention.

The STP plan has prioritised planned care as a key area for transformation: The MSK pathway forms part of the planned care work stream. The STP outlines key outcomes for the transformation including:

  • Standardised end-to-end clinical pathways.
  • Identification of activity to be delivered in the community.
  • Ensure alignment of pathways and requirements with all work programmes.

No dates have been released yet for the MSK pathway review.

The STP Prevention Plan has also prioritised the need for a number of lifestyle services including physical activity and Obesity management as a component.

The Lincolnshire Joint Health and Wellbeing Strategy include Obesity and Physical Activity as priorities; these key factors impact on MSK health.

What is the picture in Lincolnshire?

What the data is telling us

Prevalence

Public Health England produces MSK Disease Profiles, which provide meaningful data, to enable the commissioning of high value MSK services (Source: Public Health England, MSK Profiles, February 2019). All prevalence data has been obtained from these profiles.

In 2017/18, 20% of adults registered with a GP in Lincolnshire reported that they had an MSK condition; either long term back pain or long term joint pain. This proportion makes Lincolnshire significantly higher than both the East Midlands (17.9%) and England (17%) for reported MSK problems. Of those who reported an MSK problem in Lincolnshire, 21.5% also reported having anxiety or depression.

Findings from the GP Patient Survey in 2016/17 found that 10.4% of GP registered patients (n=1.037) across Lincolnshire responded to experiencing long term back pain, while 14.7% of patients (n=1,468) responded to experiencing arthritis or a long term joint problem. Both of these proportions are significantly higher (worse) than the regional and national comparators.

The latest available prevalence data from 2012 estimates that 18.7% of people (n=134,560) in Lincolnshire have some form of back pain, which is higher than the regional and national equivalents of 17.5% and 16.9%. Severe back pain is estimated to affect 11.7% of people (n=83,889) in Lincolnshire, which is higher than the East Midlands (10.8%) and England (10.2%).

Hip osteoarthritis affects 11% of adults aged 45 and over (n=39,094) across the County, while knee osteoarthritis affects 19.3% of adults aged 45 and over (n=68,671). Both of these rates are comparable with regional and national rates.

According to data from the Department for Work and Pensions, there were 9,000 people in Lincolnshire claiming Disability Living Allowance (DLA), for MSK conditions in November 2017 (Source: DWP via NOMISWeb, Benefit claimants – Disability Living Allowance by disabling condition, November 2017).

Of those MSK-related claims, more than two thirds (67.7%) of claimants were aged 65 years and over. In addition, more MSK claims for DLA were to women than men (57.5% to 42.5%).

MSK conditions made up a third of all DLA claims in November 2017, and the most common MSK-related reason for claiming DLA in Lincolnshire was arthritis (54.4%), followed by disease of muscles, bones or joints (16.1%) and unspecified back pain (13.6%). Arthritis is most apparent in the older age groups and less so in younger age groups. For claimants aged under-50 years of age, disease of muscles, bones or joints was the most common reason for claiming DLA (36.5%).

MSK and related services in Lincolnshire generate 124,698 referrals to secondary care with 175,959 associated outpatient appointments resulting in 24,644 procedures at a cost of over £75.5m per annum.

The age and gender related patterns of DLA claimants for MSK seen in Lincolnshire are comparable to national patterns.

Hospital admissions

The 2017 NHS Rightcare 'where to look pack' contains a wide range of outcomes, measures and information on the most common procedures and diagnoses for MSK at CCG level and allows for comparisons against national benchmarks to be made (Source: NHS England, NHS RightCare, January 2017). More specific information is provided in MSK 'focus packs', however these packs were released in May 2016 and contain older data (Source: NHS England, NHS RightCare, May 2016).

In 2014/15, there were 267.7 (per 100,000 population) emergency admissions to hospital due to back, neck and MSK pain. Rates were highest in Lincolnshire West CCG at 318.1 per 100,000 population and lowest in Lincolnshire East CCG (233.7 per 100,000 population). Both South Lincolnshire (261.5 per 100,000 population) and South West Lincolnshire (257.5 per 100,000 population) CCGs had rates comparable with Lincolnshire.

The average length of time spent in hospital for emergency admissions due to back, neck and MSK pain in Lincolnshire in 2014/15 was 9.6 days. Patients in South Lincolnshire CCG experienced the longest average stay in hospital, at 12.7 days. When compared, there appeared to be no correlation between hospital admission rates and length of stay.

More recent data shows that in 2015/16 there were 44.8 bed days per 1,000 GP registered population due to MSK conditions in Lincolnshire. This is comparable to the national average of 44.4 bed days per 1,000.

In 2015/16, there were 140.9 hip replacements per 100,000 population in Lincolnshire, compared to 129.6 per 100,000 population nationally. Across Lincolnshire, the highest rate of hip replacements were seen in Lincolnshire East CCG (146.5 per 100,000 population), while South West Lincolnshire CCG had the lowest rate (132 per 100,000 population).

During the same period, there were 167.2 knee replacements per 100,000 population across Lincolnshire, compared to 136.5 per 100,000 population nationally. Rates for knee replacements vary significantly by CCG, with Lincolnshire West patients having the highest rate at 198 per 100,000 population and Lincolnshire East having the lowest at 151.8 per 100,000 population.

Total spending on elective (planned) hospital admissions for MSK per 1,000 patients in 2015/16 was £45,839 in Lincolnshire. This is higher than the equivalent national spend of £39,917 per 1,000 population. Within the County, Lincolnshire West CCG spent the most on elective MSK admissions (£51,144 per 1,000) and Lincolnshire East CCG spent the least (£41,151 per 1,000).

Equivalent spending for emergency admissions for MSK (non-elective) in 2015/16 was significantly less at £4,108 per 1,000 population. Lincolnshire on average spent less on emergency MSK admissions than the national average of £4,581 per 1,000 population. South Lincolnshire CCG had the highest non-elective MSK spend at £4,318 per 1,000 population, while South West Lincolnshire CCG had the lowest non-elective spend at £3,963 per 1,000 population.

Burden of Disease

In 2017, musculoskeletal disorders accounted for 11.3% of Disability-Adjusted Life Years (DALYs) in Lincolnshire. This has increased every year since 1990 by 0.7%. This figure is even higher for Years Lived with Disability (YLDs) accounting for 23.2%.

Lower back pain is the second biggest cause of the Lincolnshire burden of disease for DALYs. It accounts for 6.3% of all burden and has a rate of 1,932 DALYs per 100,000 population. Lower back pain has increased by 18.7% since 1990, and 6.4% since 2010. Neck pain is tenth in the overall DALYs table for Lincolnshire, accounting for 2.3% and has a rate of 713.6 DALYs per 100,000 population; this has increased since 1990 by 32.5% and 6.4% since 2010.

When looking at YLDs, lower back pain is the number one cause in Lincolnshire and accounts for 13.1% of all burden. Neck pain is number four and accounts for 4.8%. Due to the fact that no deaths have been attributed to low back or neck pain there is no change to the rates.

Smoking is considered the biggest cause of musculoskeletal disorders, with the only other risk factors being attributed to occupational ergonomic and high body mass index (Source: Global Health Data Exchange, GBD Compare Tool). For further information on smoking please refer to the JSNA Topic Smoking Reduction in Adults.

Mortality

Reporting of deaths directly related to MSK disease is complex. For many cases, MSK- related deaths tend to result from potential risk factors such as falls, fractures and the recovery period from hip/knee replacement surgery. Those who have MSK conditions are at a higher risk of each of these incidents, and occurrence increases with age.

The Office of National Statistics publishes mortality data for all causes of death for a given year (Source: ONS via NOMISWeb, Life events – Mortality statistics). The latest figures show that there were over 8,500 deaths across Lincolnshire during 2017 of which 68 were attributed to diseases of the MSK system and connective tissue. This is the age and sex standardised equivalent rate of 8 deaths per 100,000 population in Lincolnshire due to MSK, which is higher than the national equivalent rate of 6.8 per 100,000 population.

The age standardised rate in 2017 increases with age from 5.4 per 100,000 in those aged 50-54 years to 234.4 per 100,000 in those aged 90 years and over. Due to small number suppression, many rates for younger age groups in Lincolnshire are not available.

Trend

Patterns in those who reporting a long term MSK problem in Lincolnshire have remained relatively static in the past three years; these have continued to be significantly worse than the regional and national average. The proportion of those with a long term MSK problem, who also reported having anxiety or depression, has risen from 20.8% in 2014/15 to 21.5% in 2015/16 and is increasing in line with regional and national trends.

Reported long term back pain has seen a small decrease in the past three years from 10.8% in 2014/15 to 10.4% in 2016/17, however rates are still significantly worse than the regional and national averages. Similar trends can be seen with reported proportions of arthritis and long term joint problems, which have fallen in Lincolnshire from 15.3% in 2014/15 to 14.7% in 2016/17.

The number of MSK-related DLA claims has fallen by 23.7% from 11,800 in November 2015 to 9,000 in November 2017. Claims by those aged between 16 and 64 years of age have fallen by 42.9% during this time, from 4,850 in 2015 to 2,770 in 2017. MSK-related DLA claims have seen a slower decline in those aged 65 years and over, falling by 10.6% from 6,810 in 2015 to 6,090 in 2017. However, this may also be attributable to the gradual replacement of DLA benefits by Personal Independence Payments (PIP).

Deaths related to diseases of the MSK system and related connective tissue has risen in Lincolnshire in the past three years from an age standardised rate of 6.1 deaths per 100,000 in 2015 to 8 deaths per 100,000 in 2017. The greatest increases however can be seen in the oldest age groups within the population.

MSK-related deaths in the 70-74 and 75-79 year age groups have more than doubled between 2015 and 2017, while the rate in the 85-89 year age group fell by 35% from 97.7 per 100,000 population in 2015 to 63.9 per 100,000 population in 2017.

Comparatively, MSK-related deaths across England fell from 7.6 per 100,000 population in 2015 to 6.8 in 2017, furthermore these reductions are consistent across all age groups.

Key Inequalities

Like other long-term conditions, obesity and physical activity are major modifiable risk factors for developing musculoskeletal problems. Our aging population, rising obesity and reduced levels of physical activity will increase the prevalence of these conditions. Yet conditions such as arthritis and back pain are commonly perceived to be unavoidable, and too few people with these conditions are aware of the benefits of physical activity and maintaining healthy body weight to improve their symptoms.

  • Nationally, 1 in 4 of the adult population are affected by MSK problems, the second most frequent cause of disability (Jong, 2011) and most frequent occupational disease (Montano, 2014).
  • MSK conditions are associated with a large number of co-morbidities, including diabetes, depression and obesity (Source: State of Musculoskeletal Health 2017 report | Arthritis Research UK).
  • People with type 2 diabetes have higher risks of developing osteoarthritis and other associated conditions which is likely to be because obesity increases the risk of type 2 diabetes as well as this form of arthritis. (Diabetes.co.uk)
  • There are inequalities in the prevalence of people reporting an MSK condition and the associated reporting of mental health illnesses such as depression and anxiety. Younger people who had an MSK condition, reported a significantly higher prevalence of depression or anxiety compared with those aged 65 years and over.
  • Impaired MSK health has significant personal, community and societal consequences, which increase substantially in older people (Arthritis and Osteoporosis Victoria, 2013). Impaired MSK health has consistently been related to increased frailty, functional decline, loss of well-being and independence and increased mortality (Cooper et al., 2010). This could lead to greater societal isolation and loneliness.
  • 40% of men and 44% of women in the poorest households report chronic pain relating to MSK , compared to 24% of men and 30% of women in the richest households.(Health Survey for England - 2012 - NHS Digital) This may suggest a lack of access to preventative measures in more deprived communities.
  • Those people living in the most deprived areas experience back pain at a relatively young age: people of working age (45–64 years) are almost twice as likely to report back pain (17.7%) as those from least deprived areas.(Source: State of Musculoskeletal Health 2017 report | Arthritis Research UK)
  • MSK disorders cause 21.3% of total years lived with a disability, second only to mental and behavioural problems (23.2%) and fourth greatest burden to health (Hoy et al., 2014).
  • Higher prevalence of MSK morbidity, impairment and sickness has been found in women in a number of MSK conditions (Gjesdal et al., 2011). The exact reasoning for this is unknown; however women are more likely to admit they are in pain and get treatment. Women are more likely than men to sustain a hip fractures and the incidence rises with age; associated with the decrease in oestrogen production after the menopause which accelerates bone loss.
  • Lincolnshire is in the highest third for prevalence of back pain in England, and has a significantly higher proportion of adults who are overweight or obese, and less physically active compared to the England average (Arthritis Research UK, 2018). For further information see the JSNA Obesity (All Ages) and Physical Activity topics.
  • Back pain and hip and knee osteoarthritis prevalence is greater in the east and south Lincolnshire CCGs (Arthritis Research UK, 2018). The exact reason for this trend is unknown, however this may relate to an ageing population, with a high percentage being aged between 60 – 69 years of age, with Lincolnshire East having the highest level of obesity across Lincolnshire.
  • In Lincolnshire South CCG population demographics suggest a higher population aged 40-49 and in their early 60s with a greater number of people carrying out manual skilled jobs such as agricultural and labouring jobs.

Current Activity & Services

Whilst a full MSK service is available to all Lincolnshire residents, the provision is inconsistent and "patchy" as currently no one organisation takes full ownership of the MSK pathway which includes Orthopaedics and Trauma, Spinal, Pain and Rheumatology conditions.

Lincolnshire East CCG commissions a Lincolnshire MSK Clinical Assessment and Treatment Service (LCATS); this service supports any MSK condition that affects the joints, muscles, ligaments or other soft tissue that causes pain and disability.

Lincolnshire West CCG decommissioned LCATS provision for their residents from December 2017; however they still continue to commission a spinal assessment service jointly with Lincolnshire East CCG (LECCG).

Services are designed to provide patients with a clinical assessment and care plan plus immediate treatment where needed. Lincolnshire's MSK Clinical Assessment and Treatment Service (LCATS) operates from six locations across the county within existing health centers and hospitals, offering care closer to home.

Lincolnshire East CCG, South and South West Lincolnshire CCG currently commissions an Any Qualified Provider (AQP) MSK Service Pain Assessment and Treatment Service. This consists of 21 qualified providers across the region; referrals are received via healthcare professionals. Lincolnshire West CCG decommissioned AQP in December 2018 but has an Interim MSK Physio Service in place.

First Contact Physiotherapy (FCP) is being piloted by South/South West Lincolnshire CCG; the pilots cover a population of 50,000 running out of the Deeping Surgery Market Deeping and Lakeside surgery Stamford; these pilots are due to terminate April 2019.

Poor MSK health can contribute to falls and frailty in people aged 65 years and over (Source: NICE CG161). Falls can be a consequence of musculoskeletal-related pain and therefore impact on mobility. Falls lead to pain, distress, loss of confidence and lost independence. In around 5% of cases a fall leads to fracture and hospitalisation. Further information on falls can be found in the JNSA Falls topic.

Frailty is defined as a distinctive health state relating to the ageing process in which multi-body systems gradually lose their built in reserves. Older people with frailty are at risk of unpredictable deterioration in their health resulting from minor stressor events. (Source: Frailty | British Geriatrics Society)

The British Geriatric Society Silver book indicates that the frailty factors are; Falls, Immobility, Delirium, Dementia, Polypharmacy, Incontinence and End of Life. (Source: Silver Book | British Geriatrics Society)

Work is underway across Lincolnshire to develop a county frailty pathway which includes falls. The pathway documentation will then be accessible via the Lincolnshire Frailty website ensuring easy navigation, referencing and support health care professionals and Lincolnshire residents. (Source: Lincolnshire Frailty Pathway)

Unmet Needs & Gaps

The current community pain management provision for chronic/persistent pain across Lincolnshire is ostensibly a pharmacological/injection led service via the acute trusts (United Lincolnshire Hospital NHS Trust, North Lincolnshire and Goole NHS Trust, Nottingham University Hospitals Trust, Sherwood Forest NHS Trust, Queen Elizabeth Hospital NHS Trust) and a range of private providers; however they do not include an alternative biopsychosocial provision. The South of the county currently has limited access to provision offered via North West Anglia Foundation Trust.

A joint CCG led commissioning and procurement exercise has taken place, a new provider has been appointed and the new county service is due to commence in April 2019, this will offer a seamless transfer for patients.

Local Views & Insights

Health Watch Lincolnshire have been active across the county in gathering patients views about Community Pain Management services and are due to participate in further engagement work planned for 2019-20. (Source: Health Watch Lincolnshire Pain Management)

In developing the Community Pain pathway contract specification, lessons were taken from the Healthwatch Lincolnshire 2017 survey and supported by bespoke patient questionnaires and completed with a patient led sense checking workshop.

Risks of not doing something

Disability resulting from MSK disorders is increasing due to ageing of the population and to increased obesity and lack of physical activity. Prevention of longer term disability is possible through a range of currently available interventions such as accident prevention, modern treatment of arthritis and MSK injuries and rehabilitation. The growing burden of these conditions can be controlled if priority and resources are given to ensure access to these interventions.

Like other long-term conditions, obesity and physical activity are major avoidable risk factors for developing MSK conditions. Obesity is expected to dramatically increase over the next decade, a major contributing factor to MSK disease and disability (Kelly et al., 2008). Further information on obesity refer to the JSNA Obesity (All ages)

Conditions such as arthritis and back pain are commonly perceived to be unavoidable, and too few people with these conditions are aware of the benefits of physical activity and maintaining healthy body weight to improve their symptoms.

Minimising the impact of MSK disability will be key to improving the quality of life for millions of people in the UK. Without forward planning and prevention strategies the years living with chronic MSK conditions will only continue to grow, thereby putting further strain on the NHS with increased cost through increased demand.

Working days lost through sub-optimal management of chronic disease are tremendous and are only likely to increase as the population ages and retirement age rises.

Demand on GP surgeries for consultations will increase, as currently all MSK conditions are initially managed in the community. One in five fit notes (466,556) issued to patients by GPs in England in 2015-16 were for musculoskeletal conditions, second to mental health and behavioural disorders; 41.9% of fit note episodes for musculoskeletal conditions last 5 or more weeks. (Source: State of Musculoskeletal Health 2018 | Arthritis Research UK)

MSK conditions cost the economy 10.8million lost working days and £4.76 billion of NHS spending each year (NHS England, 2018). This level of expenditure is only set to increase if lifestyles issues such as obesity and physical inactivity are not tackled.

Approximately 33.5 million prescriptions (up 0.2% in 2015) were dispensed for musculoskeletal and joint diseases in England in 2016, costing approximately £205.8 million (up 8.0% in 2015). Conditions such as back pain account for around 40% of all sickness absence in the NHS and costs around £400 million per year. (Source: State of Musculoskeletal Health 2018 | Arthritis Research UK)

What is coming on the horizon?

  • NHS England is working with the Arthritis and Musculoskeletal Alliance to realise meaningful activities that promote quality of life. This partnership aims to develop national MSK improvement plans that include developing strong and cohesive care networks that encourage local improvements in care and patient outcomes. (NHS England, 2018).
  • By building and ingraining local resilience and prevention opportunities, this links with delivering the Five Year Forward View. Key outcomes include realising the potential for an individual's independent living, participating in social activities, returning to work and engaging in meaningful activities that promote and restore quality of live (NHS England, 2018).
  • The MSK Networks of Care project which is a partnership between NHS England and the Arthritis Musculoskeletal Alliance, aims to foster relationships between care sectors, and share innovative and best practice. (NHS England, 2018).
  • NHS England is currently developing and sharing a number of MSK resources that include: expert webinars, blogs and presentations for commissioners, providers, clinicians and patient groups. These support development of local MSK improvement plans and are available via their online digital platform.
  • The CCGs are currently reviewing their commissioning intentions, particularly as the FCP is now in the NHS Operational Planning and Contracting Guidance 2019/20.
  • The NHS Rightcare pathway on falls and fragility fractures encourages commissioners to prioritise falls prevention, detection and management of osteoporosis and optimising support for fragility fractures. This includes case-finding those at high risk, strength and balance training to reduce falls and having multi-factorial interventions to reduce risk of falls (NHS Rightcare, 2017)
  • The MSK Workforce group involving many stakeholders are designing a competency framework, to improve the skills and knowledge of healthcare professionals; to ensure people with MSK disorders receive the right care, in the right place, at the right time (NHS England, 2018).
  • The Arthritis and Musculoskeletal Alliance knowledge network provides resources to provide frameworks for healthcare professionals and commissioners planning and developing a local MSK network.

What should we be doing next?

  • Mapping all the services and groups in Lincolnshire that offer support around MSK conditions would help to determine any unmet needs and services.
  • Programmes targeting lifestyle factors such as obesity and physical activity should explicitly include impact on musculoskeletal health
  • Health promotion messages should emphasise the benefits of physical activity to people with musculoskeletal conditions
  • Obtaining data from all services would enable a clearer picture of MSK and the impact these conditions have on other services such as Primary Care (GPs) and non- elective admissions to hospital in Lincolnshire. The CCGs should monitor access to hip surgery and to targeted prevention for falls, and plan to address any emerging inequalities.
  • Work with commissioners to ensure the PHE MSK toolkit for work place health is promoted and supported.(Source: Productive healthy ageing and musculoskeletal (MSK) health - GOV.UK)
  • Engage with people who use services and their carers/families to obtain their views around MSK provision building on the feedback gained from the community pain management engagement exercise carried out in 2017. The feedback should be used to determine unmet needs, accessibility and additional services that would support Lincolnshire residents.

 

If you need to contact us about this topic, please email JSNA@lincolnshire.gov.uk