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Focus on... Musculoskeletal services

Musculoskeletal conditions are extremely common in the community. It is estimated that nearly a quarter of adults and around 12,000 children in England suffer from a chronic musculoskeletal condition that is severe enough to limit everyday activities.

Musculoskeletal conditions are extremely common in the community. It is estimated that nearly a quarter of adults and around 12,000 children in England suffer from a chronic musculoskeletal condition that is severe enough to limit everyday activities.

Up to 30% of GP consultations are about musculoskeletal conditions, according to the European Bone and Joint Health Strategies Project (2005).

GPs have to become familiar with managing these conditions, but they are wide and varied. They can range from simple sprains and strains to the acute presentation of inflammatory arthritis. The way these conditions are managed often depends on the availability of local facilities such as physiotherapy.

The traditional model of management of musculoskeletal conditions does not work well. Patients are referred to secondary care, often enduring a wait during which there is little active management of their condition, are seen in a clinic and offered some advice or treatment, but then discharged back to primary care. Many such patients do not even need to be seen in hospital and can receive faster and more appropriate care in a community setting.

The Musculoskeletal Services Framework, published by the Department of Health in July 2006, proposes the introduction of clinical assessment and treatment services (CATS), which are multidisciplinary teams working at the interface between primary and secondary care. Such services normally offer a triage system of referrals done by physiotherapists and GPs, and then patients are directed to the appropriate clinician.

An appropriate clinician could be an orthopaedic surgeon, a rheumatologist, a GPSI, an extended-scope physiotherapist (ESP), physiotherapist, occupational therapist or podiatrist. Patients are then seen and treated in a community clinic by one of the above specialists or a minority will be referred on to secondary care straight away.

The benefits for the patient are shorter waiting times, more appropriate assessment and treatment, and being seen nearer to home. For the GP this means their patients will receive more appropriate and timely intervention.

Practice-based commissioning means GPs are now in a position to commission such a CATS service in their locality. The choice of clinicians on the multidisciplinary team will depend on local demands and which clinicians are available. However, it does mean a service can be designed for each locality's problems.

It gives control back to the GP and frees up secondary care to deal with the complicated problems or perform surgery such as joint replacements and reduces secondary care waiting lists.

It also allows GPs to develop their skills and become GPSIs. Many GPs already have skills beyond those demanded by routine surgeries and these can be developed and used in a more defined way. A GPSI can now offer his skills to local GP practices, rather than only his own patients. Job satisfaction is increased for GPs when they are able to use their specialised skills. Many diploma courses exist or are being developed to train GPs in these skills.

The NHS is changing. These are exciting times and for those who wish to embrace these changes and harness their potential, the scope to develop and improve health care is immense.

Dr Louise Warburton is a GP in Telford, Shropshire, a GPSI in musculoskeletal medicine, and a member of the steering committee of the Primary Care Rheumatology Society

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