Working Well - Health



Musculoskeletal (MSK) conditions are those that affect the bones, joints, muscles and spine, and are a largest cause of severe long term pain and physical disability in England, accounting for 31% of disability (The Lancet, 2010).

MSK disorders comprise a collection of more than 200 separate conditions, but the major groups are osteoporosis, osteoarthritis and back and neck pain. Alongside this are the many long term MSK problems relating from accidents and injuries.

Nationally nearly 18 million people live with an MSK condition in the UK, which is roughly 29% of the total population (Arthritis Research UK 2018).

The cost to the economy for MSK conditions is huge, with 10.8 million working days lost each year and over £4.5 billion spent by the NHS each year on MSK conditions (NHS England, 2018).

There are multiple risk factors that can increase a person's susceptibility to MSK problems - these include physical inactivity, being overweight and smoking. Whilst life expectancy has risen, this has increased the likelihood of MSK conditions, as the older a person is, the more likely they are to experience poor MSK health.


Global Burden of Disease data from 2016/17 shows that in England Musculoskeletal (MSK) conditions are one of the biggest causes of sickness absence from work and productivity decline in the workplace. They are the single biggest cause of pain and disability in England.

Hartlepool has the highest level of long term MSK problems in England.


Hartlepool’s level of 26.9% reporting long term MSK problem is 3% higher than the 2nd highest level for a local authority in England. This stands out as the rest of the top ten highest rates are all within 0.5% of the preceding rate. This shows that Hartlepool is not only the highest rate, but is highest by a surprisingly large margin. Looking deeper, at those whose MSK problem is just one of their long term problems, again Hartlepool has the highest level in England.


Again Hartlepool has a clear gap to the 2nd highest rate, slightly lower this time at 2.6%, while the rest of the top ten highest scoring authorities are all within 0.5% of the preceding level.

Looking at both of these side by side you can see that those reporting more than one long term condition has a much more extreme curve than those just reporting MSK problems by themselves.




Both trends have increased in 2017/18, after an initial reduction across 2015/16 and 2016/17. The sharper increase of those reporting multiple conditions means that in 2017/18 80% of those in Hartlepool who suffer from MSK problems do so as one of a multitude of long term problems.

Where MSK conditions are occurring alongside depression or anxiety, Hartlepool has seen an increase of 4.9% in 2 years. This is more than two and a half times larger than the England average, which has increased by 1.6% in the same period.


Given Hartlepool’s level of long term MSK problems it is no surprise that Hartlepool has high levels of several of the main MSK conditions. Hartlepool has the highest level in the country  for long term joint point, the 2nd highest in the country for long term back pain and the 4th highest for hip fractures in the over 65s.

However within these, long term back pain has declined by 3% since 2014/15 and is on a two year downward trend. The gap between Hartlepool and the England average is the smallest since 2013/14.


 Long term joint pain has remained stable for the last three years.


Hartlepool’s osteoporosis levels are the best in the north east.



Current Service

The current single point of access MSK Service delivers high quality, safe, evidence-based, clinically effective specialist triage of musculoskeletal referrals to ensure patients are seen in the right place, by the right person at the right time.  The service actively manages the demand for secondary care services ensuring patients have speedy access to appropriate services including therapies if required and providing continuity of care throughout the pathway.   The service promotes independence and self-management to patients, enabling the individual to restore as much function as possible using evidence based practice

The MSK service delivers a single point of access for patient management through the pathway by trained Extended Scope Practitioners (ESP) providing an improved patient experience.   An ESP is a specialist practitioner used in a similar way to a consultant; if a patient is not improving with core physio instead of referring to a consultant for an opinion a physio or GP will refer to an ESP to assess and diagnose with the use of X-ray/MRI/bloods if required. They are able to inject peripheral joint and soft tissue conditions, and have the ability to prescribe independently.  They manage patients with chronic pain in partnership with psychology to offer a physical and psychological approach to pain management.

The service also offers non-medical prescribing within the MSK service.  This allows the patient to have a medication review within the same service as they are receiving treatment to give a more holistic approach to their treatment / management plan, reduce the number of appointments needed to see different clinicians.


Future Opportunities

It is proposed that the single point of access could be expanded to include pain management of all MSK conditions for triage, treatment and onward referral if required.  It is acknowledged that 85% of pain management is for orthopaedic conditions therefore the MSK service would be well placed to triage and treat patients offering them a biopsychosocial approach to pain management.

An expansion to the single point of access for other specialities particularly Rheumatology is also being considered.

The Regional Back Pain programme for patients with acute low back pain is already in place within the single point of access however discussions are taking place to allow for consideration of patients with chronic, long term low back pain access to the programme.

In line with NHS Long Term Plan and new network DES contract requirements for GPs, CCGs are working closely with emerging Primary Care Networks to scope and implement the First Contact Practitioner role across primary care which aims to enhance MSK provision.