The Future of Musculoskeletal (MSK) Health
UK Population, 2022
people live with an MSK condition in the UK
First Contact
Local Service:
Early intervention via prompt access to MSK in the community
of patients treated by First Contact Practitioner Osteopaths were discharged without need for onward referral
EASE GP & PARAMEDIC WORKLOAD
REDUCE NHS WAITING LISTS
BETTER MENTAL HEALTH OUTCOMES
AFTER ONE WEEK 89%
AFTER SIX WEEKS 93%
Standard Pathway
MSK
DEPRESSION 4X MORE LIKELY
1.06M HOSPITAL ADMISSIONS
47% LONG-TERM MSK PATIENTS
1 IN 10 UK EMPLOYEES
70% ADULTS
OVER HALF (54%) OF ADULTS
Summary
The current patient experience of the NHS system and trajectory of government spending is clear, unless primary and secondary care services are integrated to improve accuracy of referrals and reduce the burden of musculoskeletal (MSK) health. Therefore, the First Contact Practitioner (FCP) role is a key component of the NHS Long Term Plan. Any Allied Health Professional (AHP) with skills relevant to the role can operate as an FCP, offering diagnostic services out of GP surgeries nationwide.
MIND THE GAP
Currently, there is a gap between government proposals announced in the budget on 15th March 2023 regarding the scaling up of Musculoskeletal (MSK) hubs in the community and the operational reality, particularly for osteopaths. Osteopaths are excluded from Additional Roles Reimbursement Guidance (ARRS), the means by which First Contact Practitioners in the context of NHS employed roles are funded locally. These FCP roles are open to any AHP with relevant MSK skills. Until recently, this naturally included osteopaths, but under a recent review, osteopaths have been omitted from the list of those that can be employed via this particular funding stream to fill these roles. As such, all osteopaths currently working in FCP roles in the NHS will need to be funded through other streams or may have to be redeployed. We would argue that based on the findings of the pilot study and the contribution that NHS FCP osteopaths who are already working in these roles are making to patient care, of which there are many, this is a mistake that needs to be rectified.
The particular focus on MSK conditions, whilst evidenced and essential, is yet to manifest itself sufficiently in local Integrated Care Board (ICB) strategies and future planning. This echoes our belief that actions are currently poorly aligned with directives and a lack of professional recognition in the form of student funding for osteopathic students reflects this:
Osteopathy students are not eligible for standard student support and the NHS Learning Support Fund (LSF).
The pandemic shone a light on the value of osteopaths, who continued to serve patients either face-to-face or online. With increasing NHS waiting times and fewer face-to-face consultations, patients have been willing and grateful to receive holistic care from those in private practice. This increase in patients has meant an increase in associated job opportunities yet ironically recruitment for students has decreased. The headwinds of Brexit, the pandemic, and now the cost-of-living crisis have significantly impacted Higher Education recruitment and retention across the wider health sector but are particularly acute in osteopathy in comparison to other AHPs, due to the anomalies in student funding already mentioned. The time has come to include osteopaths, as valued stakeholders in future workforce planning, to discuss and ameliorate these professional and funding disparities.
