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Memorandum of Understanding with the BSR
Memorandum of Understanding
Between the British Orthopaedic Association (BOA) and the British Society for Rheumatology (BSR)
Our common interest
We have a common interest in the delivery of excellent services for people with musculoskeletal conditions. Our joint intent is caring for patients and supporting musculoskeletal physicians and surgeons in the delivery of care of the highest quality. Our members are committed to delivering this and we are keen to work together to support them to achieve it.
Our common aims
With the aim of delivering better quality, more focused, responsive, and efficient services, we are calling for:
1. A National Clinical Director for musculoskeletal conditions to improve coordination of services, supported by a DH Musculoskeletal Group.
2. Implementation of a refreshed Musculoskeletal Services Framework (with strong leadership from our professional groups and patient bodies) to improve quality.
3. Properly informed commissioning to ensure patients receive the best possible care through rapid access to appropriate specialist expertise when needed.
4. Promotion of greater knowledge of musculoskeletal disorders both within primary care and to the public more generally, to ensure early diagnosis and treatment.
The health care opportunities and benefits
We recognise that the NHS is about to face an extraordinary period of significant change and spending restraint. There is a growing emphasis on efficiency and quality combined, which will shape the models of care and pathways of the future. However, we believe that there is a substantial opportunity to deliver musculoskeletal services to patients that are faster, better quality, and more efficient:
1. Musculoskeletal conditions are a significant area of health spending; action taken now could offset the increasing cost of an aging population.
2. The significant cost of waste in the present system (from unnecessary investigation, duplication of services and needlessly long pathways), could be saved.
3. Doing so could increase the quality of care, as well as generating cost efficiencies. In particular, there is evidence that delays for patients in presentation, referrals and diagnosis if addressed, could generate long-term savings for the health service and economy.
4. The Musculoskeletal Services Framework, if refreshed and implemented, would provide a platform from which to achieve this.
5. General practitioners could improve primary services for patients, if given the support, training and incentives necessary.
6. Good management of musculoskeletal conditions can keep people working longer and leading more personally, socially and economically productive lives.
Our common concerns
We share concerns about the current quality of services for people with these conditions:
1. There is increasing recognition of the current weaknesses in musculoskeletal care pathways that are sub-optimally planned, commissioned in a fragmented way, and without national direction.
2. Current targets for the treatment of musculoskeletal conditions are not being met, with 44% of hospitals failing to meet the 18 week target in admitted pathways in orthopaedics.
3. Many primary care trusts do not include musculoskeletal conditions within their definition of long-term conditions, and spending on patients varies substantially.
Our health care partners
We know that quality is best delivered through strong partnerships, and so:
1. We recognise the critical importance of working with the multidisciplinary team to achieve real quality.
2. We believe that colleagues in primary and secondary care need to work together to deliver the seamless treatment that our patients need.
3. We know that our patients play a vital role in bringing about the necessary change which is needed.
4. Our members (as orthopaedic surgeons and rheumatologists) struggle to overcome a number of challenges to patient care and service delivery, and we believe that by working more closely together we could deliver better services for our patients.
5. We recognize the need for our members to be effective partners locally with strong patient and public support.
We will work to improve services by:
We feel that these changes would be best supported by our members' engagement, and with that in mind we plan to work together to secure the following:
1. Quality: By promoting the development of high quality, cost effective pathways (clinical and commissioning). We will encourage strong leadership from rheumatology and orthopaedics to empower multidisciplinary teams to develop and implement pathways which improve quality, reduce delays, increase productivity and are cost effective across all musculoskeletal conditions.
2. Teamwork: We will seek to develop the wider musculoskeletal labour force working alongside our members. We believe that all members of the team should have the competencies they need, and the support required to develop the right professional skills for the job. We will lobby for increased training for general practitioners in musculoskeletal conditions. We will seek to ensure proper support for extended role practitioners.
3. Evidence: By identifying and focusing on those areas of research that will generate the most clinically and cost effective service delivery models and therapies for the future. As part of this we will seek to ensure that we engage in government pilot schemes, and ensure that they are appropriately assessed.
4. Policy: We will work together in advocating the appropriate recognition and long term funding that our patients and their disabilities deserve. Since all these will require changes in policy, we believe above all in the need to partner closely with ARMA to collaborate on work with the Department of Health and the NHS to press for the development and implementation of a revised and more clinically effective musculoskeletal services framework.