Herts Valleys Community Integrated Musculoskeletal (MSK), Rheumatology, Pain and Postural Stability Service

With increasing pressure on the NHS, innovation is key in order to preserve services for future generations.

The Integrated Musculoskeletal (MSK) service was the first of a number of new style services that Herts Valleys CCG established as part of their commitment under the ‘Your Care, Your Future programme’ to provide patients with healthcare in community locations. This new community based approach – which moves away from the traditional hospital outpatient model – is one that patients have called for and is also in line with recommended practice nationally.

Connect Health commenced the Herts Valleys Community Integrated Musculoskeletal Service in January 2018, based in a number of locations across the locality, including a brand new hub site located in Hemel Hempstead, with ample parking, 5 mins from the local hospital.


Challenges that needed to be met by the new service

  • MSK affects a significant proportion of the population and there was a major need to ensure equity of access for patients requiring MSK care
  • There was a need to refine primary care engagement especially with the move to Primary Care Networks (PCNs)
  • If changes were not made to the pathway, there would have been a continued rise in cost, increased falls and potential decrease in quality over time
  • The mix of multiple AQP providers would have led to further fragmentation and inconsistent service delivery
  • It was imperative to implement a single standardised, transparent, coordinated, patient pathway for MSK and pain services, eliminating inefficiencies and inconsistencies


What does the integrated service cover?

It is a fully integrated MSK service that provides a single point of access for NHS patients and encompasses:

  • Single point of access
  • Tier 1: Physiotherapy, rehab therapy
  • Tier 2: Clinical Assessment and Treatment Service (CATS)
  • Community Pain
  • Community Rheumatology
  • Hand therapy
  • Postural stability
  • Podiatry


Service outcomes

Cost savings

  • 2018/19 – Pathway saw 15,000 more activity, with a £2.5million saving compared to 2017/18
  • Community MSK activity increased 13% in the same period
  • Savings based on activity in trauma and orthopeadics, rheumatology, pain management, injections, physiotherapy and hand therapy


  • 41% average improvement on waiting times Jan-Dec 19 compared with Jan-Jul 20 across all service lines
  • Demand outstripped projected levels – the service saw a significant increase in referrals above plan across all service lines


Patient outcomes and feedback

  • Over 80% of patients are likely or extremely likely to recommend us to their friends and family*
  • This has increased from 70% when Connect Health first commenced the service (*based on 1640 respondents, between Jan-Mar 2020)

Quality of life improved by 25%

  • Patients have shown an improvement in EQ5D quality of life, with an annual improvement score rising from +0.15 in April 18 to +0.19 in Jan 20 (comparing favourably to the average of previous studies of +0.16)

Our patients are at the core of everything we do. Listening to people who use and care about our services gives us a better understanding of their health needs and what matters to them.

Corey Harding, Service Manager, Herts Valleys


The impact of Covid-19 on service delivery

Across the Connect Health Herts Valleys CCG team, we redeployed 6 clinicians into the NHS front line during the spring/summer of 2020, whether that’s working in a Rehab Team on a ward to enable people to be discharged home quicker or in physio roles in various other locations such as Neuro or Inpatients.

Read Senior MSK Physio Alex Beechey’s redeployment story


Connect Health was better prepared for Covid than most of our community providers because they were already carrying out virtual and telephone appointments through PhysioLine and PhyisoNow, so the transition from face to face patient appointments was seamless.

There is still work to do in terms of improving communication between primary, community and secondary care but the MSK service has really improved over the last year, cutting waiting times and improving patient satisfaction.

In addition, Connect has to be commended for their support to NHS frontline services in Herts Valleys during the Covid-19 pandemic, whether providing colleagues in rehab teams on a ward to enable people to be discharged home quicker or in physio roles in various locations such as neuro or inpatients.

Asif Faizy, Clinical Lead, Herts Valleys CCG


Working in partnership

The future service aims to be a modern, patient-centred and joined-up health and social care system:

  • Further collaboration with Talking Therapies – formerly known as Improving Access to Psychological Therapies (IAPT) –  in West Hertfordshire (i.e. joint teaching sessions Connect Health and IAPT)
  • Establishing relationships with current FCP providers in West Hertfordshire
  • Collaboration with ICS, community and secondary care partners e.g. clinician rotations, frailty pathway, community rheumatology stable review pathway
  • Ongoing MSK pathway transformation e.g. PhysioNow digital triage tool, self referral, GP advice line, virtual pain management programmes


Read the full case study

View the Herts Valleys service page