The introduction of primary care commissioning of musculoskeletal (MSK) services is a
much-needed opportunity to redesign an outdated, hospital-oriented system of care.
This system was set up long before advances in physiotherapy, exercise and drug
interventions resulted in opportunities for community-based services to achieve better
outcomes and enable more efficient use of resources.
The NHS now spends over £4 billion per year on MSK services, making MSK disorders
the fifth highest area of NHS spending1 (Figure 1). How we redesign and commission
MSK services today will direct provision across the country for at least the next 20 years.
It is therefore essential that we develop a patient-centred, integrated system which
addresses the full range of public health, NHS and social care needs associated with
MSK disorders. However, the system must also be sufficiently flexible to enable clinical
commissioning groups to adapt their services to local situations and requirements.
Figure 1: The burden of MSK disorders2
• About 1 in 4 adults are affected by longstanding MSK problems
• MSK conditions are responsible for up to 30% of GP consultations
• MSK disorders are the most common reason for repeat consultations with GPs
• Up to 60% of people who are on long-term sick leave cite musculoskeletal
problems as the reason
• 40% of people over 70 have osteoarthritis of the knee
• An estimated 8–10 million people in the UK have arthritis, including 1 million
adults under the age of 45, upwards of 12,000 children and 70% of 70-year-olds
• Upwards of 400,000 adults in the UK have rheumatoid arthritis, about
200,000 have been diagnosed with ankylosing spondylitis, and as many as
177,000 have psoriatic arthritis
• Low back pain is reported by about 80% of people at some time in their life
• Over 3.5 million calls per year to emergency services relate to MSK injuries
or conditions
• Over 1 in 5 people with MSK disorders receive incapacity benefits
This Guide has been written by the Primary Care Rheumatology (PCR) Society for its
members and others who are involved in commissioning MSK services. Its
recommendations are based on the expert opinion of those attending a two day
meeting, held earlier this year, to address the commissioning issues associated with the
development of MSK services. It is part of an ongoing initiative with the Arthritis and
Musculoskeletal Alliance (ARMA), the British Society for Rheumatology (BSR) and the
British Orthopaedic Association (BOA).
The guide uses the most relevant of the rapidly growing array of electronic information,
templates and tools being developed by the Department of Health (DH) and
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professional organisations to support implementation of the reforms proposed in Equity
and excellence: Liberating the NHS3 and revised in response to recommendations from
the NHS Future Forum4 (Figure 2). Just as importantly, it draws on the knowledge and
insights of healthcare professionals and commissioners with first hand experience of
developing and providing MSK services for the modern era