Delivering Care for Patients with Musculo-Skeletal (MSK)


Health services across Coventry are coming together to provide a new way of delivering care for patients with a wide range of musculo skeletal (MSK) conditions. The service will bring together elements from primary care, community and hospital services to improve access to services and help patient better manage their conditions. University Hospitals Coventry and Warwickshire NHS Trust and Coventry and Warwickshire Partnership NHS Trust are working collaboratively with the Clinical Commissioning Group and Primary Care Networks to design the new model.

What is an integrated pathway?

The aim of the new model is for patients to receive the Right Care, at the Right Time in the Right Place. The integrated MSK service will support people at all points on the pathway, starting with prevention of MSK conditions through promotion of healthy lifestyle approaches.

Why is the service changing?

MSK conditions place a high demand on primary, community and hospital services, making up 20% of all GP appointments. Demand is growing as the population ages. We also know that about 30% of people referred to hospital to see a specialist come away with no outcome, and are often discharged back to their GP. This is not a good experience for patients or the NHS.

The current model in Coventry is not meeting the needs of people affected by MSK issues and is not sustainable in the face of growing demand on local NHS services. An integrated pathway, where patients will have access to a number of healthcare professionals, including Physiotherapists, can provide the best possible health and wellbeing outcomes.

What does the new model of care look like?

Many musculoskeletal problems are long term conditions that require comprehensive care and pain management strategies by a variety of health professionals and across a range of services. Patients can be referred to a multi-disciplinary hub to receive the most appropriate management rather than to hospital as a first option.

Where is care being delivered?

Pilot clinics led by First Contact Practitioners (FCPs) have been taking place in a number of GP practices in Coventry.  Following successful evaluation, including positive feedback from patients, clinics have now gone live in 19 GP Practices across Coventry.

What is a FCP?

An FCP is usually a Physiotherapist who has the advanced skills necessary to assess, diagnose and manage musculoskeletal problems.


Interview with Dr Christopher Newton, Consultant Physiotherapist

Tell us a little about your background before UHCW?

I started my career as physiotherapist more than 17 years ago, gaining experience in a variety of musculoskeletal roles both within primary and secondary care. In the second half of my career, I have worked as an Extended Scope of Practice physiotherapist within spinal orthopaedic clinics, an Emergency Department, Primary Care Clinics and musculoskeletal physiotherapy. I have a particular interest in persistent pain. I hold a masters degree in advanced musculoskeletal practice and I have just completed my PhD that evaluated a complex intervention for people with persistent low back pain.

What’s your role at the Trust?

I’m a newly appointed Consultant Physiotherapist, a first for UHCW. My role is to act as the clinical lead for the new musculoskeletal pathway for Coventry and support the team of First Contact Practitioners within the Primary Care Networks as well as working within these clinics myself. I will also provide clinical leadership to the musculoskeletal physiotherapy teams at both UHCW and Coventry and Warwickshire Partnership Trust. I intend to continue my own clinically based research as well as build research capacity linking with the Centre for Care excellence and opportunities for training and development for all staff working across the MSK pathway.

How will you work with the MSK pathway programme – what’s your vision?

The vision of the pathway is simply to provide the right care to the right person in a timely manner and appropriate location. Currently a large proportion of referrals to secondary care could have been managed more effectively at an earlier point along the pathway by allied health professionals without the requirement for referral to secondary care. I’m also really keen that we ensure that the people using our services, the service providers and all of our partners are involved so we achieve the ultimate goal which is to provide high value care for the people of Coventry. In the future I would like to see Coventry recognised nationally as a being a centre of excellence for musculoskeletal care.

What has been taking up your attention since you’ve been in post?

At the time of speaking to you, I’m 11 days into the new job and I’m also new to Coventry. My priority has been to meet people working in the service, understand current service provision and pathways, the proposed MSK pathway, as well as assisting with preparations for the roll out of First Contact Physiotherapy (FCP) within the PCN’s, which is launching in April. I have been out to visit pilot FCP sites, meeting frontline staff and our partners and I have been really encouraged by what I have seen.

What are the benefits of the new MSK pathway?

Musculoskeletal conditions place a huge burden on individuals, healthcare and society, for example low back pain is the number one cause of disability globally. The new MSK pathway has the potential to reduce this burden. Evidence from other integrated MSK pathways in the UK highlight improved patient outcomes, enhanced patient satisfaction and better use of secondary care services which all result in significant cost savings for the health economy (e.g. reduced imaging requests and prescribing costs).

The pathway places specialist MSK practitioners (e.g. FCPs) at an earlier point in the pathway who have undertaken extensive training in the assessment, diagnosis and management of patients with musculoskeletal conditions. A very experienced and skilled workforce has been recruited to work along the pathway. They will have access to the necessary training and supervision which ultimately should translate into better care for patients.

Do you have a message for staff working on the new MSK pathway?

Yes, I’m so excited to be working with you all. As a new team we have a real opportunity to provide a streamlined, evidenced-based pathway that will provide higher value care for the people of Coventry. There are going to be so many opportunities for personal and professional development. It really is a great time to be working in Coventry.