Across The Divide: Joined-Up Working

Abstract

Musculoskeletal therapists traditionally enjoy greater autonomy in private practice. The UK Department of Health’s Musculoskeletal Services Framework (July 2006) encourages National Health Service (NHS) service provision to be transferred from the secondary to the primary sector. This reduces overall costs whilst increasing the responsibility and autonomy placed on GPs and therapists working in the NHS.

This Government’s objective is to drive down waiting lists for hospital care whilst increasing patient responsiveness within the NHS. The NHS reform agenda consists of linked policies to achieve this: Practice-based Commissioning, The 18 Weeks Waiting Initiative, Patient Choice, Choose and Book and Payment by Results. This editorial discusses how to co-ordinate the implementation of each reform to achieve seamless care from initial patient contact in primary care through community-based clinics to secondary care with support from commissioners and providers alike. Community Foundation Trusts are one of several new vehicles for providers joining across primary and secondary care to implement the Musculoskeletal Services Framework, as Primary Care Trusts divest themselves of their therapist provider functions by 2009.

Service providers must respond rapidly to the reforms imposed whilst maintaining ethical operating principles within the NHS internal market. Commissioners must ensure that service changes are: in patients’ best interests, evidence-based and cost neutral. Good clinical governance is essential to ensure that therapists are working within their realms of competence without compromising patient safety or good clinical care.

Service re-development should “Start Small, Grow Big.”

Key Words:

• musculoskeletal service development
• practice-based commissioning
• foundation trusts
• patient choice
• internal market
• autonomy