Musculoskeletal (MSK) conditions are common and patients report that their conditions are not recognised as debilitating and they are not receiving the support needed. Millions of people are limited by pain, stiffness and fatigue caused by MSK conditions, such as arthritis or back pain. All aspects of everyday life are affected including function, independence and mental health, impacting on overall quality of life.

MSK conditions are the leading cause of years lived with disability (YLDs) and third largest cause of disbaility adjusted life years (DALYs) in the UK. (Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. (2016)

The prevalence of MSK conditions is increasing due to an aging population and rising levels of obesity and physical inactivity. MSK conditions and their management should be everyone’s business, creating a platform on which to explore the potential of non-clinical champions, supporting care pathways and self management, elevating pressures on primary care.  Building upon the PHE Making Every Contact Count (MECC) methodology we have yet to explore the role in which non-clinical champions can support self-management and effective access to MSK care pathways.

MECC:

• An approach to behaviour change that utilises the millions of day to day interactions that individuals have with others to support them in making positive changes to their physical and mental health and wellbeing
• Enables the opportunistic delivery of consistent and concise healthy lifestyle information, enabling individuals to engage in conversations about their health

By effectively and efficiently mobilising research knowledge into healthcare practice, the Impact Accelerator Unit (IAU) at Keele University is dedicated to making a significant and lasting impact on both the quality of life and care of those with, or at risk of, arthritis and MSK conditions, as well as associated co-morbidities such as mental health. The IAU was created in 2016 in response to increasing demand for proactive support in implementing innovations emerging from the high quality research at the Research Institute for Primary Care and Health Sciences.

High quality evidence based innovations from the IAU include: STarT Back – stratified care for low back pain; and JIGSAW-E – Joint Implementation of Osteoarthritis Guidelines across Western Europe. These provide case study innovations where the peer support concept (Communities of Practice) has been trialled and provides the foundation to move forward with a test bed for MSK health champions in primary care.

STarT Back provides a cost effective way for CCGs to stratify low back pain and ensure patients access the right treatment at the right time in line with NICE guidelines using an electronic template, high quality training and bespoke information. MECC for low back pain has been an output of this innovation.

JIGSAW-E provides clinicians with high quality resources to support patients with an enhanced self-management programme for Osteoarthritis. It is making a positive impact across the West Midlands bu giving clinicians the confidence to implement change and challenge pathways e.g. high rates of imaging and referral to Orthopaedics.

Both innovations support patient self-management for long term MSK conditions. To date this has been health care professional led but as the projects have developed, opportunities have presented to expand and develop the role of non-clinical staff and champions to promote a MECC approach. The NICE guidance on Community Engagement recommends recruiting community members “to plan and deliver health promotion activities and help address the wider determinants of health”. It describes both health champions and community champions as people able to inspire and motivate community members but also able to advocate for change and influence local organisations.

This proposal  would explore the potential of MSK health champion roles in the community, supporting the MECC concept of self-management for MSK long term conditions.

1) Create a Community Health Champion network, initially in the West Midlands. The network will provide peer to peer support for the champions and the space to share experience and learning – initially utilising two clear case studies outlined in point 2/3 below. The network will be led by MSK clinical champions from the IAU.

2) Develop a MECC low back pain tool and training for non-clinical champions, complementing the package already developed for health professionals.

3) Providing the champions with access to bespoke patient information for the conditions of Osteoarthritis and low back pain. This will include signposting opportunities to local support for patients.

4) Create strong network links between the community champions and local authorities and CCGs in their locality, embedding the role into MSK pathways. Champions will be skilled to deliver the core messages (outlined in points 2/3 above) to individuals in PPG groups in primary care, community groups, carers groups, patient groups and individual one to one opportunities with members of the public.