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Chance-Larsen K1,2, Backhouse M2,3, Collier R4, Wright C5, Gosling S6, Harden B4, Marsh S7, Kay P7, Wyles H5, Mattick K8, Erwin J9, Woolf A9,10
1University of Central Lancashire, School of Health Sciences, Preston, United Kingdom, 2University of Leeds, Leeds, United Kingdom, 3University of York, York, United Kingdom, 4Health Education England, London, United Kingdom, 5Skills for Health, London, United Kingdom, 6Chartered Society of Physiotherapy, London, United Kingdom, 7NHS England, London, United Kingdom, 8University of Exeter, Exeter, United Kingdom, 9Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom, 10Arthritis and Musculoskeletal Alliance, London, United Kingdom
Background: Musculoskeletal (MSK) conditions account for 30% of General Practitioner (GP) consultations in England1 and are associated with co-morbidities including diabetes, depression and obesity. MSK conditions account for £4.76 billion of National Health Service (NHS) spending each year2. Emerging first point of contact practitioner roles in primary care have been piloted in GP practices and have demonstrated a positive impact, including better clinical outcomes, less prescribing, more appropriate onwards referrals, better conversion rates for surgery, high patient satisfaction scores and reduced GP workloads3.
Purpose: We aimed to support service transformation by developing a core capabilities framework for first contact practitioners working with people who have MSK conditions. Health Education England and NHS England commissioned development of the framework to support the transformation of services, to place skilled MSK practitioners earlier in the patient pathway.
Methods: We conducted a modified three-round Delphi exercise with a multiprofessional panel of 41 experts nominated through 18 national professional and patient organisations. Qualitative data from an open ended question in round 1 was analysed using a thematic approach and combined with existing literature to shape a draft framework. Participants rated their agreement with each of the proposed 142 outcomes within 14 capabilities on a 10-point Likert scale in round 2. The final round was then developed by the project management group (the authors) combining round 2 results with a wider online survey. This wider open survey sought feedback from a diverse range of clinicians wanting to provide comments or feedback. Four patient focus groups across England explored what people with MSK conditions want from their initial consultation, and ensured the face validity of the framework.
Results: Rounds two and three of the Delphi study were completed by 37 and 27 participants respectively. 90 practitioners responded to the wider online survey. 16 participants (11 female) aged 19 to 75 took part in the focus groups, with conditions including inflammatory arthritis, osteoarthritis, back and neck pain and sports injuries. Key themes from the focus groups helped shape the framework and confirmed face validity.
The final framework contains 105 outcomes within 14 capabilities, separated into 4 domains. The median level of agreement for all 105 outcomes was ≥ 9 in the final round.
Conclusion(s): The framework describes the capabilities required for practitioners working in first point of contact roles for people with MSK conditions and is now being disseminated by Health Education England, NHS England and Skills for Health across England and is being incorporated into practice and service re-design.
Implications: The framework provides a standard structure and language across professions, thereby promoting greater consistency and portability of MSK core capabilities. The framework enables:
Keywords: Musculoskeletal, Core capabilities, First point of contact
Funding acknowledgements: Health Education England and NHS England provided funding for this project.
Purpose: We aimed to support service transformation by developing a core capabilities framework for first contact practitioners working with people who have MSK conditions. Health Education England and NHS England commissioned development of the framework to support the transformation of services, to place skilled MSK practitioners earlier in the patient pathway.
Methods: We conducted a modified three-round Delphi exercise with a multiprofessional panel of 41 experts nominated through 18 national professional and patient organisations. Qualitative data from an open ended question in round 1 was analysed using a thematic approach and combined with existing literature to shape a draft framework. Participants rated their agreement with each of the proposed 142 outcomes within 14 capabilities on a 10-point Likert scale in round 2. The final round was then developed by the project management group (the authors) combining round 2 results with a wider online survey. This wider open survey sought feedback from a diverse range of clinicians wanting to provide comments or feedback. Four patient focus groups across England explored what people with MSK conditions want from their initial consultation, and ensured the face validity of the framework.
Results: Rounds two and three of the Delphi study were completed by 37 and 27 participants respectively. 90 practitioners responded to the wider online survey. 16 participants (11 female) aged 19 to 75 took part in the focus groups, with conditions including inflammatory arthritis, osteoarthritis, back and neck pain and sports injuries. Key themes from the focus groups helped shape the framework and confirmed face validity.
The final framework contains 105 outcomes within 14 capabilities, separated into 4 domains. The median level of agreement for all 105 outcomes was ≥ 9 in the final round.
Conclusion(s): The framework describes the capabilities required for practitioners working in first point of contact roles for people with MSK conditions and is now being disseminated by Health Education England, NHS England and Skills for Health across England and is being incorporated into practice and service re-design.
Implications: The framework provides a standard structure and language across professions, thereby promoting greater consistency and portability of MSK core capabilities. The framework enables:
- service commissioners to specify minimum standards of clinical care;
- service providers to demonstrate that staff meet the standards of the nationally recognised framework, or have developmental plans in place to do so;
- education and training providers to deliver training and development opportunities by informing curriculum, education and training programme design;
- practitioners to map existing skills and learning needs against role requirements.
Keywords: Musculoskeletal, Core capabilities, First point of contact
Funding acknowledgements: Health Education England and NHS England provided funding for this project.
Topic: Service delivery/emerging roles; Musculoskeletal
Ethics approval required: Yes
Institution: University of Leeds
Ethics committee: School of Medicine Research Ethics Committee
Ethics number: MREC16-009
All authors, affiliations and abstracts have been published as submitted.
