The Five Year Forward View was first published in October 2014 so the ‘Next Steps’ marks the halfway point. We should welcome the stated desire to create the environment and structures (new resources in primary care and accountable care systems/organisations) to shift money away from many of the high cost/low value interactions that have developed over the years. Whether clusters of 30-50k patients into primary care hubs is large enough is questionable but at least it’s a start. More questionable is half of UK general practice being in one of these hubs in 12 months!
It was heartening to hear Simon Stevens specifically refer to MSK physio being one of the tools that can be used to increase capacity in primary care and relieve pressure on hospitals. Connect has been doing so since 1993 and currently cares for 250k patients a year in the community and can therefore bring its experience to help foresee some of the potential challenges supporting service design and implementation to avoid unintended negative consequences. The objectives are clear – better outcomes in the community at less cost – the ‘how’ is less obvious.
For example, where community MSK services have been fragmented (through General Practice Fund Holders then Any Quality Provider) quality has diminished, onward referrals into hospital have increased and poorer outcomes in the community also mean greater cost. Conversely MSK services based in primary care/community but centrally managed have provided a positive ‘pull’ to GPs and patients because they are ‘user friendly’ and deliver better outcomes. And the taxpayer gains too.
So, I welcome the recognition that MSK physios in the community deliver for patients and commissioners but let’s not reinvent the wheel or indeed fit the wrong tyres.