The CSP is challenging Lincolnshire ICB's lack of clarity over what future MSK services will look like after existing contracts were put under review, says Professional Adviser Pip White.
The CSP is pressing the ICB for clarity after members told us that contracts with the 13 MSK Any Qualified Provider (AQP) services were under review with plans to remove these sometime in early 2025.
Though it's not clear what will replace these services, a service user consultation indicates several options are being considered including a package of group exercise, online education and other services.
The CSP is pushing for answers, pointing out that the demand for physio services should not be redistributed to other parts of the healthcare system without an increase in workforce, as this could increase waiting lists.
A lack of information from the ICB has done little to address concerns over what steps are being taken to ensure cases of serious pathology are not missed, causing harm to patients.
When you need to share bad news there are three golden rules - tell people the truth, tell them quickly and tell them yourself. Unfortunately, the ICB has so far failed on all three counts.
It has shared limited information to frontline staff, with no apparent communications strategy to address the serious concerns and alarm already raised by AHP service leads representing our members delivering MSK services within Lincolnshire.
The inclusion of the MSK agenda within the ‘Personalisation’ and ‘Health Inequalities and Prevention’ sections of the Lincolnshire 2023-2028 Joint Forward Plan underscores the importance of redesigning MSK pathways to improve access and outcomes. MSK issues, such as back pain, are a significant health challenge in Lincolnshire, affecting around 14% of the working-age population.
With MSK recognised as one of the ‘Big 6’ health priorities within the Plan, it is essential that the quality of MSK service provision is maintained, and it is critical that physiotherapy service provision is appropriately designed and resourced to meet the needs of the local community.
The ICB may well argue that it can't provide any definitive answers while it's consulting on the future of MSK services for Lincolnshire by seeking the views of service users. However the questions asked do not seem to address the totality of MSK service commissioning.
Effective MSK care pathways often necessitate a coordinated approach across pain management, rheumatology, emergency departments, and related services such as imaging and diagnostics to provide patients with comprehensive care that is safe, effective and efficient.
These work together to get a patient on the right care pathway at the right time - and it remains worryingly unclear whether this bigger picture has been factored into the ICB's plans, and if so, how the MSK redesign aim to support these interconnected services.
MSK rehabilitation is as essential as medicines and surgery, as it adds quality to a person’s life enabling them to pursue what matters to them.
Effective rehabilitation also lowers demand on front-door services, including A&E, by preventing unnecessary readmissions and appointments, which alleviates strain on the most costly parts of the NHS.
Rehabilitation accelerates and maximises recovery, helping people return to work and live independently, therefore it is imperative that any revision to MSK services considers the whole health system.
The risk of harm to patients from introducing a new, arguably worse service that falls short of these standards will continue to be raised. And the CSP will be seeking to engage in a robust dialogue with the ICB to ensure changes do not impact negatively on existing MSK and diagnostics services, or First Contact Physiotherapy (FCP) and community rehabilitation services.
As we know, FCP physiotherapists provide initial assessment, diagnosis and first-line treatment which may include referral for ongoing physiotherapy treatment. As a person-centred service, most appointments include self-management advice, social prescribing, and discussions about physical activity and fitness for work. They don't provide full rehabilitation services.
We will keep pressing for answers, because our members and the population of Lincolnshire deserve better.
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