Musculoskeletal (MSK) health includes bones, cartilage, ligaments, tendons and connective tissues. A wide range of disorders and conditions can lead to problems in the musculoskeletal system. Ageing, injuries, lifestyle and disease can cause pain and limit movement.

MSK conditions account for 30% of GP consultations in England. Low back and neck pain are the greatest cause of years lost to disability in the UK, with chronic joint pain or osteoarthritis affecting more than 8.75 million people in the UK.

In Birmingham and Solihull:

  • 22% of people are physically inactive, which leads to a lot of joint, bone and muscle problems.
  • 30% of all our GP appointments are related to musculoskeletal conditions.
  • Access to services are not equitable across Birmingham and Solihull.
  • We don't do enough to help people self manage their conditions and prevent themselves from becoming unwell.

Why is transforming MSK services such a priority?

Since 2005/6 total outpatient appointments have nearly doubled from 60.6m to 118.6m. The pandemic has only made this situation more challenging with lots of people requiring treatment, espeically for MSK related conditions.

There is also unwarranted variation in activity and outcomes across England, as shown by RightCare. Timely access to high quality elective care is a key priority, as set out in the NHS Constitution. Transforming MSK services is a priority across the whole NHS.

The local picture in Birmingham and Solihull

  • In Birmingham and Solihull, we have similar challenges to the rest of the UK. While we do have some amazing examples of MSK practice and some really talented clinicians, there still exists a significant challenge.
  • Musculoskeletal health is essential for maintaining economic, social and functional independence, as well as human capital across the life course.
  • 22% of people are physically inactive, which leads to a lot of joint, bone and muscle problems.
  • 30% of all our GP appointments are related to musculoskeletal conditions.
  • 9% people in Birmingham and 21.5% people in Solihull have a long term MSK condition.
  • The productivity gap for the West Midlands includes a £1.1bn wider health impact, predominantly MSK related conditions.
  • As waiting times for surgery increase, quality of life deteriorates. 25% patients awaiting a knee replacement score their pain as ‘worse than death’.
  • There are significant health inequalities within MSK, as pathways have not been developed based on population need, nor services established by PLACE.
  • Demand for high volume procedures (e.g. hip & knee replacements) continues to increase, yet.
  • People living in deprived areas are twice as likely to wait more than a year for joint replacement.
  • People from disadvantaged communities are less able to participate in physical activity and do not tend to engage with traditional exercise programme delivered within the NHS 24.8% of adults living in Birmingham and 23.2% of adults in Solihull are ‘physically inactive’.
  • It is imperative that BSOL pioneers health prevention and supported self-management: supporting inactive people (those doing less than 30 minutes per week) to become more active could prevent 1 in 10 cases of stroke and heart disease.

Who is delivering the programme

The programme is being delivered by partners from across the Birmingham and Solihull Integrated Care System, which includes Birmingham Community Healthcare NHS Foundation Trust, Royal Orthopaedic Hospital NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust and NHS Birmingham and Solihull Clinical Commissioning Group. ​​​​This is a collaborative programme for all of Birmingham and Solihull.

getUBetter: a digital tool for MSK patients

We are introducing a tool called 'getUBetter' for people in Birmingham and Solihull (BSol). getUBetter is a digital tool which provides 24/7 self-management support for people with MSK conditions.

People are supported digitally through their recovery day-by-day with personalised, evidence-based behavior change techniques which includes symptom checking, nudges, videos, exercises and outcome measures.

It supports people to self-manage their recovery and only be re-directed to healthcare services when necessary. This is much better for people because they are empowered to recover with the right information and support. It's also great for healthcare providers because they can help people on to the most appropriate care pathway.

We know that a digital solution doesn't suit everybody, but getUBetter will be a fantastic tool for those who use digital tools. Find out more here.

If you would like to be a 'test user' for getUBetter, we would love your feedback. Please tell us more about how the app feels to you. You don't need to be an expert, just prepared to take a look and tell us what you think. Simply contact us via email to find out more.


CrossCover OrthoPathway: supporting clinicians

We are introducing a tool called CrossCover OrthoPathway that will support clinicians to make the best treatment and support decisions for people with MSK conditions.

Across Birmingham and Solihull there is a significant amount of variation in the treatments available to people with MSK condiitons. For example, you might get offered something in Sparkhill that isn't available in Erdington. We are working hard to improve these care pathways so that everyone has access to the same high-quality treatment.

As we improve pathways, we are working with clinicians to support them to make the best referral choice for every patient, so that everyone has access to the best, most appropriate care depending on their condition.

That's where CrossCover OrthoPathway comes in.

CrossCover OrthoPathway is a tool that clinicians will use when they are in a consultation with a person who has an MSK conditions. CrossCover OrthoPathway will help them make the right referral choice quickly.

That's fantastic for patients because they get access to the best treatment. It's great for health and social care providers too because it makes it easy to make the right referral choice. Watch a video explaining CrossCover OrthoPathway here.

If you would like to find out more about CrossCover OrthoPathway we would love your feedback. You don't need to be an expert, just prepared to share your views. Simply contact us via email to find out more.


The signposting project

The Signposting Project will make it easier to find resources to support your health and wellbeing.

In Birmingham and Solihull there are lots of different resources, services and sources of information to support your health and wellbeing. These include things to help you be more physically healthy and mentally healthy, but also things that indirectly support your wellbeing - like financial advice or housing support.

Finding the right support can be a challenge both for local people and for clinicians who want to direct their patients.

We want to make signposting easier, so we're working with partners in the BSol ICS to improve access to information. We're calling it 'the signposting project' and we're keen to get you involved.

We're keen to listen to you and create a signposting tool that meets your needs. Maybe you like things online, or perhaps you prefer paper? Maybe you have accessibility needs that should be considered or you want to suggest local resources that could be promoted. Please contact us and get involved in helping support improved signposting in Birmingham and Solihull.


Patient information: helping everyone find the right resources

We are working to make sure everyone in Birmingham and Solihull has access to the same high quality, accessible and appropriate patient information.

There's loads of great information available to support health and wellbeing. However we know that sometimes services don't make it easy for people to access this information. We're working on a project to help make the best MSK-related patient information available to local people.

Having the right information can make all the difference with MSK (and all health conditions). It can support people to optimise their recovery as well as self-manage their conditions.

Would you like to help us by reviewing information? Your feedback can help us ensure the information we share is useful and practical for people. If you would like to help, please contact us via email.


Workforce: preparing for the future

This project is about ensuring we have the right people in the right roles to create a high quality, sustainable local MSK service, fit for the future.

We know that providing early and appropriate support to people with MSK conditions is beneficial. That's why roles like the 'First Contact Practitioner' (FCPs) are so important for the future - because putting MSK expertise into Primary Care can help people to get the right support in good time.

This project is about looking at all of the different MSK associated roles across Birmingham and Solihull and planning for the future. This project, in combination with the work we do on pathways will have a profound impact in the future.


Standardising pathways: reducing variability and increasing quality

We want to ensure that there is a standardised pathway for MSK patients in Birmingham and Solihull.

We know that there is variation in the MSK services and experiences people have across Birmingham and Solihull. This simply isn't good enough. Everyone should be able to access the appropriate service and treatment regardless of where they live.

This project is all about standardising MSK care pathways. We know what good looks like and there are lots of great services locally. We will make sure that everyone can access them.

Initial Partner Meeting

In June 2021, we invited clinicians from across Birmingham and Solihull to an 'MSK Pathway Redesign workshop'. The event helped to shape our ambition and encourage collaborative planning. View the report here.

Pathway Workshops

In November 2021, we invited clinicians from across Birmingham and Solihull to begin mapping out pathways and begin the practical work of creating standardised pathways across a number of clinical specialities. View the report here.

The national MSK agenda

A five year strategic framework for MSK prevention is available to read here. The purpose of this document is to provide stakeholders and our system collaborators with a clear statement of PHE, NHS England and Versus Arthritis’s commitments to promote MSK health and to prevent MSK conditions. This document will also be of interest to a wide range of organisations working on prevention of MSK conditions in the private, international and research sectors.

NHS England: MSK
Read more from NHS England on MSK health and elective service recovery

Best MSK health
Read the presentation 'The future of MSK and the Best MSK health Collaborative #BestMSKhealth' by Andrew Bennett, National Clinical Director Musculoskeletal Conditions at NHS England and NHS Improvement.

The MSK Digital Playbook
Learn about digital solutions to support the patient journey through secondary care here.

Primary and community musculoskeletal adult services restoration principles
NHS England and NHS Improvement (NHSE/I) outline key principles to inform the restoration of primary and community musculoskeletal (MSK) services both within the context of the Third Phase NHS response to the Coronavirus pandemic and reflecting the ambitions of the Long Term Plan. The document is available in the musculoskeletal section of the Elective Care Community of Practice website.
You can view the restoration principles by joining the community (account required).

Versus Arthritis

Versus Arthritis is the UK's largest charity dedicated to supporting people with arthritis. We are working with Versus Arthritis locally. They have developed lots of fantastic resources to support peoplw with MSK conditions. Find out more here.

The State of Musculoskeletal Health 2019
Complied by Versus Arthritis, 
The State of Musculoskeletal Health 2019 provides a compendium of statistics that aims to provide the best picture available on the current overall burden and subsequent impact of MSK conditions in the UK today.

If you work in an ICS partner organisation or work with people in Birmingham and Solihull who might be interested in this programme, please find a range of resources to support your communication and engagement.

If you're interested in finding out more about this programme, please contact the programme team via email: roh.comms@nhs.net