Community MSK

GIRFT’s community MSK workstream is working to better enable integrated care systems to commission the delivery of high quality MSK services in the community, which will benefit patients now and into the future.

MSK conditions affect over 20 million people in the UK, around 1/3 of the population. Each year, up to 30% of GP consultations in England are for MSK conditions. Waiting lists for MSK community services are high in England, at around 350,000 people in September 2024 (348,799) – the highest of all community service waiting lists.

The central aims of the workstream are to:

Ensure high-quality triage services and optimise referrals for diagnostics and for orthopaedic, rheumatology and spinal services.
Enable delivery of high-quality therapies to rehabilitate those who have sustained an injury or are recovering from surgery, and to support people to develop the knowledge, skills and confidence to best manage long-term MSK conditions and helping them to remain in or return to work.
Integrate digital health therapeutics.
The work is being delivered as part of the Further Faster initiative.

Andrew Bennett

Community MSK clinical lead

Clinical lead for community MSK , consultant physiotherapist Epsom and St Helier NHS Trust

Andrew is a consultant musculoskeletal physiotherapist within Sutton Health and Care, hosted by Epsom and St Helier NHS Trust. He provides expert clinical practice and leadership within Community MSK services, transforming the local framework for delivering triage and therapies, integrating first contact practice, digital health technologies, local leisure services, virtual multidisciplinary meetings, and referral pathways to spinal, orthopaedic, rheumatology and pain management services. He has gone on to take a lead expert specialist role within the Southwest London Integrated Care System.

He is a non-medical prescriber, a member of the Musculoskeletal Association of Chartered Physiotherapists, and former co-chair of the consultant physiotherapist special interest group within the Chartered Society of Physiotherapy.

Andrew was NHS England’s National Clinical Director for MSK from 2019-2024 – the first Allied Health Professional to hold an NCD role. He led the MSK response to the coronavirus pandemic, working closely with professional and patient facing stakeholders and being recognised for championing co-production and driving integration across systems. He went on to take a lead role in recovery, leading the former BestMSK health pathway improvement programme, working with GIRFT on improving pathways of care and enabling referral optimisation, and writing the improvement framework to help reduce community MSK waits whilst delivering best outcomes and experience.

He has supported the Major Conditions Strategy work in collaboration with the Department of Health and Social Care, as the well as the delivery of the MSK related labour market measures announced in the 2023 Spring Budget.

Alongside his GIRFT clinical advisor role, he is also providing clinical leadership for the NHSE Digital Health Therapeutics Programme.

GIRFT MSK Community Delivery Programme

GIRFT has been awarded funding from the government’s Joint Work and Heath Directorate (JWHD) for a programme of activity working with integrated care systems (ICSs) and community MSK providers with the highest waiting lists for elective community MSK services.

The GIRFT MSK community delivery programme is working across England with the aim of providing system level leadership to support community MSK providers in recovering waiting time performance and transforming their services.

An initial pilot was launched in 2024/25 with £3.5m from the Joint Work and Heath Directorate to support 17 ICSs to improve the quality and accessibility of MSK services. This was later extended to support six more ICSs with a further £2.2m of funding.

Evaluation showed that the programme contributed to a 20% reduction in 18+ week community MSK waiting lists in the first cohort of 17 participating integrated care systems (ICSs) between December 2024 and March 2025.

Following this success, a further £3.2m of government funding was awarded to support interventions including MSK community appointment days (CADs) – one-day clinics that bring health specialists and mental health support and physical activity services together, allowing people to engage with multiple services in one visit – and ‘super clinics’, which increase clinical capacity by providing one-to-one assessment, targeted treatments and in-depth clinical diagnostics in a single clinic.

The programme’s focus is to reduce waiting times for a community MSK appointment; to improve access to MSK treatment and support people back to work. Additional funding from NHS England has also been identified to enable local systems to prioritise timely access to care.

The GIRFT MSK Community Delivery Programme supports integrated care systems to:

Improve the quality and accessibility of MSK services to help people with MSK conditions get back to work sooner.
Strengthen NHS MSK infrastructure and improve performance.
Improve health and work outcomes for people with a MSK condition.

Further Faster operational handbook

The programme is being delivered using the principles and methodology of GIRFT’s Further Faster 20 programme, which is working with systems and NHS trusts to go ‘further and faster’ in transforming patient pathways to reduce waiting times in areas of high economic inactivity.

As part of the MSK work, GIRFT has produced an operational handbook which provides checklists against which community MSK leads and ICSs can assess current practice and delivery of services. The handbook contains information on a range of resources and aligns with the principles and actions shared in NHS England’s Improvement Framework to reduce MSK waits whilst delivering best outcomes and experience.

The GIRFT handbook signposts to resources that support practitioners to:

Optimise referrals to community triage and therapies services.
Ensure appropriate triage is in place to recognise urgent conditions requiring onward referral to secondary care.
Deliver rehabilitation and self-management.
Reduce number of ‘did not attend’ (DNA) incidences and implement patient- initiated follow-up (PIFU) appointments.

Community MSK leads

The programme aims to provide system level leadership to support community MSK providers in recovering waiting time performance and transforming their services.

This includes national and regional leads helping to apply the GIRFT ‘Further Faster’ model and developing quality improvement resources, alongside 25 system leads supporting community MSK providers in recovering waiting time performance and transforming their services.

Andy Saunders

Community MSK clinical advisor for First Contact Practice

Advanced physiotherapy practitioner and clinical lead for the First Contact Practitioner service within Midlands Partnership University NHS Foundation Trust

Andy is an advanced physiotherapy practitioner and clinical lead for the First Contact Practitioner service within Midlands Partnership University NHS Foundation Trust.

As the GIRFT community MSK clinical advisor for First Contact Practice, he is working to undertake a rapid analysis of current service provision and subsequently provide recommendations for future practice. He is also supporting with expert specialist knowledge in this area of MSK practice.

Alongside his current roles, Andy is also the chair of the Midlands FCP clinical forum and guest lecturer at Keele University.

Philippa Norris

Community MSK clinical advisor for work and health

Advanced practice musculoskeletal physiotherapist at Manchester University NHS Foundation Trust and First Contact Physiotherapist in primary care.

Philippa has extensive NHS experience managing complex musculoskeletal conditions and a specialist interest in population health and health inequalities. She works across a Tier 2 Orthopaedic Interface Service and as a First Contact Physiotherapist in primary care.

In 2024, she was appointed a project lead for the Manchester Work-Well Vanguard at Manchester University NHS Foundation Trust, leading the integration of employment support within MSK pathways to help individuals remain in or return to work.

Philippa also contributes at a system level as a member of the Manchester University NHS Foundation Trust Population Health Steering Group, supporting trust-wide efforts to reduce health inequalities.

Joseph Russell

Community MSK clinical advisor for commissioning

Associate Clinical Director at Allied Health Professionals Suffolk

Joseph is an experienced physiotherapist working across a range of MSK settings and is currently responsible for clinical quality and service standards at Allied Health Professionals Suffolk, a community interest company.

He has a strong interest in understanding the broader impact of health interventions beyond traditional clinical measures and has published work exploring the use of Social Return on Investment (SROI) as a framework for evaluating healthcare outcomes in a more holistic way.

He is a keen advocate of digital healthcare and the potential of technology to improve productivity, quality of care and patient outcomes.