Integrated Musculoskeletal Teams

Musculoskeletal medicine has undergone a considerable change since the Department of Health released the musculoskeletal services framework in 2006.  Clinical musculoskeletal teams in the UK have moved away from the familiar physician-led model and the use of extended scope practitioners is now widely accepted as best practice. Musculoskeletal teams mostly consist of extended scope practitioner physiotherapists although, in some NHS trusts and MSK partnerships, other allied health professionals such as podiatrists, osteopaths and occupational therapists work alongside physiotherapists in multidisciplinary musculoskeletal teams.

I am currently writing an initial scoping document aimed at assessing the current makeup of musculoskeletal teams and looking at any quality, efficiency and productivity improvements that can be made by making musculoskeletal teams truly multidisciplinary.  I am very interested in hearing the opinions of musculoskeletal physicians, nurses, clinicians, and allied health professionals working in musculoskeletal multidisciplinary teams or those that are interested in doing so.  I also welcome comments from patients, professional bodies and healthcare regulators.

It could be argued that the clinical role of an extended scope practitioner is predetermined by the position in the care pathway that the extended scope practitioner is working in (usually between the patient’s general practitioner/physiotherapist and secondary care consultants).  My question and interest relates to whether non-physiotherapist clinicians can work as extended scope practitioners rather than should we be integrating osteopathy, podiatry or occupational therapy (as examples) within musculoskeletal NHS teams – the efficacy of which is a different topic entirely.

As a guide, I’m interested in comments from potential and existing extended scope practitioners or from physicians that work alongside non-medical clinicians in this field.  I am interested in what training issues there might be, what governance arrangements might be necessary and particularly any potential conflicts that you might foresee.

Having worked in multidisciplinary teams for the vast majority of my 20 year NHS career I can only see advantages but I have benefited from supportive, forward-thinking employers and colleagues that have patient management as a core value.  I appreciate, however, that working in a multidisciplinary team might pose a number of questions and it is this that I am trying to explore in this scoping exercise.

Please feel free to comment below or use the contact page should you wish to discuss this privately.  I am happy for comments to be anonymous but will moderate out abusive comments et cetera.


10 tips for NHS clinical redesign teams

1. Tailor the clinical redesign to answer the question – why are the commissioners redesigning this particular clinical service?

2. Patient-centre every single stage of the care pathway.

3. Acknowledge the vital importance of the GP in each stage of the care pathway.

4. Ensure both secondary care and primary care clinical teams are part of the redesign process from the very start.

5. A redesigned community service is useless if secondary care provision is compromised in any way. Ensure the secondary care provision is adequate.

6. Use of Extended Scope Practitioners should be limited to their specific knowledge base.

7. Remember that not all clinical roles can be delegated to allied health professionals.

8. Medical consultant leadership is not a luxury, it is a necessity.

9. Use storyboarding techniques for clinical incidents as well as plaudits.

10. Ensure the winning service provider sets regular contractually compliant governance points – evaluate every fifth of the contract.