BOA submission to the Primary Care Workforce Commission

About the British Orthopaedic Association

The British Orthopaedic Association (BOA) is the Surgical Specialty Association for Trauma & Orthopaedic Surgery in the UK, representing approximately 40% of the surgical workforce. We promote excellence in professional practice, training and education, and research as part of our mission to care for patients and support surgeons. BOA Evidence The BOA welcomes this opportunity to contribute to the work of the Primary Care Workforce Commission. We also hope to have continued engagement with the Commission, Health Education England (HEE) and other interested parties. Our submission includes and builds on the following work:

• The BOA’s Undergraduate syllabus for Trauma and Orthopaedic Surgery. The Syllabus is a flexible guide to teaching aimed at increasing the knowledge of future General Practitioners (GPs) in orthopaedic conditions. The syllabus targets medical students in recognition that 50% of medical students will ultimately become GPs. 

• Getting it Right First Time. Getting it Right First Time is a NHSE-DH funded review of elective orthopaedics, led by the BOA. Whilst its focus is on secondary care, it highlights that referrals to Orthopaedics from GPs are increasing at a rate of 7-8% a year and recommends that GPs are provided with education in the benefits of different implant practices. A key priority of GIRFT is to promote service reconfiguration to ensure critical mass in orthopaedic capacity and to centralise activity in high-volume networks. It is in this context that there should be greater integration between Primary Care and Orthopaedics. 

• Restoring Your Mobility. Restoring Your Mobility is the BOA’s Professional Practice Strategy. A key priority within the Strategy is greater integration between Primary Care and Orthopaedics so as to address the growing demand for Orthopaedic interventions and unnecessary variation in access to surgery.

• The BOA’s NICE-Accredited Commissioning Guidance documents. These provide clear and evidence based care pathways, based on input from patients, the BOA and colleagues across the multi-disciplinary team, as per NICE processes. It is essential that service configurations facilitate smooth transitions within these pathways and that training and education produces the necessary skills mix to direct patients through them.  

The BOA’s priority for Primary Care is to ensure that General Practice and Primary Care Physiotherapy are effectively integrated with Orthopaedics. An excellent example of this integration is the Integrated Back Care Pathway developed in Aberdeen under the auspices of NHS Grampian. The model is based on joint General Practice and Physiotherapy management in Primary Care, linked to an MSK-hub providing specialist assessment and physiotherapy, which is in turn linked to secondary care. As a result of this model, triage now straddles primary and secondary care, providing smooth transitions through the pathway for patients.

The BOA’s view is that the development of models similar to this, and alternative models of integrated care, would be well supported by increased knowledge of MSK conditions in General Practice. This is reflective of the fact that that 30% of GP consultations relate to MSK conditions, as well as the rate of growth in MSK presentations to GPs. It also reflects the short period of training, of approximately 4 weeks, that GPs receive in MSK. The BOA undergraduate syllabus was developed to address this issue, and we recommend that HEE and the GMC encourage its adoption by medical schools across the UK.