1. MSK Practitioner programme South Hampshire Vanguard Multi-specialty Community Provider

2. Expanding the workforce An experience practitioner is providing an MSK service based in a practice. Patients are offered the option of an appointment with a GP or with the MSK practitioner. The aim is to increase the capacity within general practice and evaluate whether this is a cost effective model that cab be replicated. The practitioner is trained to take a history, examine patients and make a diagnosis. They are also able to request and interpret X-rays, MRI and CT scans. They advise on management, exercise, undertake steroid injections, refer to physiotherapy and orthopaedic outpatients.

3. Workforce implications Many physiotherapists reduce their scope of practice as they become more experienced. They will then focus on the management of a single joint. Some choose to leave the NHS and move into private practice in order to be able to extend their scope of practice. The project was seen as a way of developing career opportunities for experience physiotherapists.

4. Outcomes 183 contacts red = activity Green = % OC = referral to orthopaedic dept GP = returned to GP

5. Conditions seen

6. Use of templates The templates are designed specifically for the MSK practitioner. This allows easy data entry into the patient’s GP record. In addition, the template links to referral forms for investigations and links to self help advice leaflets.

7. Patient satisfaction As part of the pilot it was important to evaluate patient satisfaction. All patients who were seen were asked to complete a satisfaction survey. There was a 100% patient satisfaction with the service. Patients were satisfied with the outcome, none expressed a view that they would have preferred to be seen by a GP.

8. Conclusion The service was had strong patient support. Potential improvement in quality was seen An MSK practitioner can replace some GP appointments therefore adds capacity. There are wider benefits to the NHS: Reduced physiotherapy referrals Reduced referrals to orthopaedic service Potential reduction in imaging Improvement in self management strategies

9. Next steps Expand the service and provide the service through the primary care access centre. Review MSK pathway. Develop a MSK service within a locality embedded in general practice but including MSK practitioner and physiotherapy service. Develop the workforce with support from Health Education Wessex.