The NHS 10-Year Plan: Our Organisational Response
In October, the NHS invited everyone to share their thoughts on the NHS 10-Year Plan. The Faculty asked our membership to provide their own experiences and ideas to the NHS. We have collated and reviewed all of the responses and have since submitted our Faculty response to the NHS. We would like to express our gratitude and thanks to all the members who responded to this extremely important body of work. It is crucial that the Faculty continue to best represent our membership and this document provided us an opportunity to do so.
The following is a summarised version of our response, which focuses on musculoskeletal (MSK) medicine and physical activity.
Musculoskeletal Medicine (MSK)
To significantly improve the management of musculoskeletal and the other conditions outlined, the 10-Year Health Plan must:
- focus on Musculoskeletal (MSK) Medicine
- prioritise SEM by:
- increasing the number of Sport and Exercise Medicine (SEM) consultant posts
- increasing the SEM consultant training posts and locations
- ensuring SEM Involvement in the commissioning of MSK services nationally to build sustainability and diversity into the workforce
- address the workforce inequalities
- focus on the prevention and maintenance of health
The Faculty can support the move for care from hospitals to communities by providing standard setting and governance structures, while there also needs to be a focus on the multidisciplinary teams (MDTs) working in MSK health, shifting care back to primary care with the appropriate safeguards in place.
When asked about challenges and enablers to make better use of technology in health and care, the Faculty expressed the need to establish more virtual multidisciplinary teams, as well as clinical, educational and governance meetings to improve patient care, patient engagement and healthcare team collaboration. Another priority included improving access to physical activity data using existing technology that the vast majority of the population use, such as smartphones, which would enable conversations at patient level and help inform healthcare planners, town planners and governmental structures.
We also strongly emphasised the current limitations that exist surrounding the capacity and capability of the multi-professional workforce in having conversations around physical inactivity. By training the multi-professional team to have meaningful conversations around physical activity, it will identify one of the major drivers for ill health.
The Faculty identified the following policies that could each be implemented within 12 months:
- The provision of education and training of resident doctors and Allied Health Professionals (AHP) should be mandated as part of any tender for the delivery of any NHS service by non-NHS providers. This is particularly relevant for MSK community care.
- The mandated requirement of Trusts to provide dedicated time in consultant and Specialty and Associate Specialist job plans for education, supervision and training of the multi-professional workforce, not just time for resident doctors. Educator capacity is a barrier to the delivery of the multi-professional vision of the 10-year plan.
- Extension of prescribing capability, which includes joint and soft tissue injections, should only be given to professional groups that are regulated.
Physical Activity
The Faculty also emphasised that physical activity isn’t a ‘nice to have’, but is essential to health and wellbeing, preventing and managing chronic conditions, keeping people healthy and in work, and improving population health. We believe the 10-Year Health Plan must embed physical activity into every aspect of health and care across the life course, building more support at the systemic level, particularly for those who are most inactive and those with existing health conditions.
We feel the offer the NHS can make towards supporting physical activity can be cost effective and would achieve much in a relatively quick period through some key interventions as suggested in this organisational response.
Currently, NHS providers, both in primary and secondary care, are not routinely trained, empowered or contractually enabled to deliver a consistent approach to physical activity for people living with long-term conditions. The physical activity sector can expand the capacity and capability of the health and care workforce to shift from hospital to community. Shifting care to communities will require the empowerment of healthcare professionals to do things differently. Health and care professionals need to feel knowledgeable and supported if they want to embed movement and physical activity in their practice through training, resources and good relationships with physical activity organisations.
Clinicians need to better understand how and when to ask for and use this data to improve patient journey and outcomes. Integrating digital solutions in healthcare can increase physical activity and improve health outcomes across populations. Embedding consistent data standards for physical activity will also allow us to capture the long-term impact of innovation and create easier signposting to local offers. We also feel there should also be better use of the NHS App and digital prescription generation to provide NHS messages to patients about the importance of physical activity in their disease management.
The Faculty believes that integrating physical activity into health and care pathways is key to the prevention and management of long-term health conditions. Physical activity helps to both prevent health conditions emerging and manage ongoing long-term conditions by reducing pain and disability. The NHS workforce must also be supported to increase their own physical activity. Investment in the physical and mental health of the workforce through movement and physical activity, creates a happier, healthier, and more productive NHS which is essential for high-quality care.
The Faculty put forward a number of policy ideas in the response, categorised into short-, middle- and long-term.
Short-term
In the short-term, there should be an enhanced and increased volume of messaging through multiple NHS touchpoints around physical activity. Improving both the clinical and public health leadership of physical activity implementation at NHSE is another short-term option, as well as removing barriers around risk for patients living with the symptoms of long-term conditions.
Middle-term
Middle-term, the Faculty would like to see the introduction of mandatory training for all Healthcare Professionals on conversational techniques and physical activity delivery. This training already exists and has been implemented and assessed through the Physical Activity Clinical Champion’s (PACC) Programme. The Faculty believe it needs to be upscaled and mandated for all clinicians working with patients with long term health conditions.
Long-term
Over a longer period, there needs to be a concerted effort to implement NICE guidelines, which take a specific focus on physical activity. There are currently over 100 NICE documents which specifically mention PA as an integral part of Chronic Disease Management. We believe there needs to be further guidance about implementation of these guidelines learning specifically from previous project work. Currently there is a non-uniform and highly variable approach to implementation across the NHS, which should be standardised for specific disease pathways.