Developing a national musculoskeletal core capabilities framework for first point of contact practitioners.

Kenneth Chance-Larsen,Richard Collier,Jo Erwin,Colin Wright,Sarah Marsh,Michael R Backhouse,Sally Gosling,Anthony Woolf,Beverley Harden,Peter Kay,Hilary Wyles

doi:10.1093/rap/rkz036

Abstract

ObjectiveWe aimed to support service transformation by developing a core capabilities framework for first contact practitioners working with people who have musculoskeletal conditions.MethodsWe conducted a modified three-round Delphi study with a multi-professional panel of 41 experts nominated through 18 national professional and patient organizations. Qualitative data from an open-ended question in round one were 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 two. The final round combined round two results with a wider online survey.ResultsRounds two and three of the Delphi survey were completed by 37 and 27 participants, respectively. Ninety practitioners responded to the wider online survey. The final framework contains 105 outcomes within 14 capabilities, separated into four domains (person-centred approaches; assessment, investigation and diagnosis; condition management, intervention and prevention; and service and professional development). The median agreement for all 105 outcomes was at least nine on the 10-point Likert scale in the final round.ConclusionThe framework outlines the core capabilities required for practitioners working as the first point of contact for people with musculoskeletal conditions. It provides a standard structure and language across professions, with greater consistency and portability of musculoskeletal core capabilities. Agreement on each of the 105 outcomes was universally high amongst the expert panel, and the framework is now being disseminated by Health Education England, NHS England and Skills for Health.

Highlights

It is estimated that 17.8 million people in the UK live with a musculoskeletal (MSK) condition and that these conditions remain the leading cause of years lived with disability and the third largest cause of disabilityadjusted life years in the UK today [1]
The framework outlines the core capabilities required for practitioners working as the first point of contact for people with musculoskeletal conditions
Agreement on each of the 105 outcomes was universally high amongst the expert panel, and the framework is being disseminated by Health Education England, National Health Service (NHS) England and Skills for Health

Summary

Introduction

It is estimated that 17.8 million people in the UK live with a musculoskeletal (MSK) condition and that these conditions remain the leading cause of years lived with disability and the third largest cause of disabilityadjusted life years in the UK today [1]. Musculoskeletal conditions are the second largest cause of sickness absence in the UK; they are responsible for the loss of >30 million working days per annum [2], and there is a significant impact on employment rates of people with an MSK condition [3]. The combination of an ageing population and rising levels of obesity means that the burden of MSK conditions is likely to increase over the coming years [6]. This will place further pressure on already stretched GP services and requires new approaches and health service transformation to meet the changing needs of the population. One recent innovation has been the emergence of first contact practitioners (FCPs), which aims to place skilled MSK clinicians, typically from non-medical backgrounds, earlier in the patient pathway, with the aims of improving patient outcomes and reducing GP workload

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