Musculoskeletal medicine training cost-effectiveness: Reduction in secondary-care referrals

Abstract

Aim

To determine whether cost-savings result from postgraduate education for general practitioners in musculoskeletal medicine.

Method

Three separate days of postgraduate education in musculoskeletal medicine were carried out for general practitioners, covering early diagnosis and management of common musculoskeletal disorders, with emphasis on clinical examination and aspiration and injection techniques. Following the course, the practitioners were asked to keep a diary noting cases which did not need referral to secondary care as a result of the knowledge obtained and skills learnt from the training. These details were collected and costed by the commissioning group who had paid for the training.

Results

Figures were available from 17 of the 23 doctors attending the training. Two hundred and twenty-six referrals to secondary care were avoided, the treatments given including injections. The equivalent secondary-care costings were calculated to be £64 952–£148 002, compared with the £50 413 cost of primary care treatment plus the cost of training. A minimum saving of £14 538 is calculated for 12 months practice, with a possible £97 615 over 3 years.

Discussion and conclusion

This self-reported observational survey suggests that simple postgraduate education in musculoskeletal medicine can be cost-effective. The cost savings may be multiples of the figures quoted as a result of more expensive care being applied in secondary care: other benefits may include improving the patient experience, expediting pain relief, prevention of chronicity, improving hospital efficiency and conversion rates, and improving patient (and general practitioner) satisfaction.

Keywords:

• Musculoskeletal
• Postgraduate education
• Cost-effectiveness
• Injection
• Primary care

Acknowledgements

Deena Niren of the British Institute of Musculoskeletal Medicine Roadshow for data procurement. Dr Robert McNeilly and Nikki Brooker of Hastings & Rother Clinical Commissioning Group.