MSK physiotherapy service standards implementation

The first Musculoskeletal (MSK) Physiotherapy Service Standards were launched in January to wide acclaim from the profession. The focus is now on implementation.

The standards clearly describe the importance of personalised care in physiotherapy service delivery and training.

CSP chief executive Karen Middleton said: ‘This has been a huge piece of work in collaboration with members. It is really important work for our members and, ultimately for the care the public receives.’

While CSP professional adviser Julie Blackburn added: ‘These standards are vital to providing organisations and MSK physiotherapy services with a standardised way of measuring good practice.’ 

Throughout 2021 Annette Bishop, the commissioned researcher and lead author for the Standards, worked closely with a working group to develop the first draft set. In September the Standards were open to consultation with multiple stakeholder groups including clinicians, patients, charity partners and commissioners. 

Their aim is to:

• help CSP members to improve MSK services
• support and empower physiotherapists in evaluating current MSK practice, identify individual and service learning needs, whilst also addressing potential gaps in service
• provide patients and the public with the knowledge to support informed decision making within MSK services

Alongside the Standards are: video introductions to the Standards, top tips for implementing the Standards, examples of putting them into practice and an audit tool. 

There are eight separate standards, with quality measures for each. They are applicable to any healthcare setting within the UK and are aimed at services supporting adults over the age of 16. 

The Standards should be used in conjunction with competency frameworks and have been developed from high level evidence, including National Institute for Health and Care Excellence (NICE) guidance. 

Shaping the project

The project was funded by the CSP Charitable Trust and was  supported by a working group consisting of MSK researchers, service managers and clinical leads, a patient and public representative, and CSP research and professional advisers.

Stakeholders for all key audiences were consulted at each stage of the project and CSP members also had the opportunity to give feedback on the draft standards, metrics and audit tool.

To comment further on the project email mskstandards@csp.org.uk 

Top tips for implementing MSK physiotherapy service standards

Five top tips to think about when using the musculoskeletal (MSK) physiotherapy service standards in a MSK pathway or physiotherapy service

1. Read and share

Make sure the team understand the relevance and importance of the standards and take time to go through them and address any questions and issues or ideas for implementation with members of the team. 

2. Data collection is key

Have a simple and easy data collection template that can be accessed and utilised. Data collection needs to be accurate in order for maximum service improvement to be achieved. See our standards audit tool and creating meaningful data.

3. Delegate and recruit

Have one lead person in charge of data collection. This can be a great way to get members of the team, including students and support workers involved in audits and data collection and part of wider service improvement opportunities. 

4. Prioritise 

These standards do not have to be used and embedded all at the same time. It may be the case that a service needs to focus or prioritise one or two of the standards initially. Over time you can then focus on the standards that are less of a priority. 

5. Dedicate time

It is important to have dedicated non-clinical time within any job plan to allow clinicians to participate in audits, data collection and service improvement activity. See the NHS AHP job planning guide for more information.

How can you use these standards to improve your MSK service

We spoke to some MSK service leads and heard their views on the importance and need for the standards, possible barriers and some top tips for how clinicians might go about implementing the standards in different settings.

Helen du Toit, MSK clinical and APP lead, Royal Free London NHS Trust

‘Time and resources for staff to read, implement and evaluate the standards is important. 

‘Having an awareness of your demand and capacity ratio would be useful in whether there is enough resource to support the use of these standards in practice, and what is missing within the service.

‘Job planning with staff and having the time to look at CPD and how this is factored in is important.’

Andrew Cuff, consultant MSK physiotherapist, Connect Health

‘Don’t try and implement all at once. A simple gap analysis would show areas for improvement, and a good idea would be to start at this point by using the most relevant service standard. 

‘These standards need to align with what we do in the future within MSK services.

‘This is a good opportunity to benchmark any MSK service and a good starting point would be to use these new standards as a checklist to start with. The eight domains are on point and represent what services should be looking at now and in the future.’

Phil Ackerman, consultant physiotherapist, NHS Lothian

‘The new standards are very welcome to support MSK service improvement. Shared decision-making is one example of a standard which our services have used to provide ongoing service evaluation. It is good to see the endorsement of this theme in the standards and consider how it can be implemented and measured’.

Suzanne Kennedy, team lead and consultant physiotherapist, Northern Health and Social Care Trust 

‘Having or identifying a lead for the implementation of the standards within the service would be one of our team’s priorities. 

‘If someone takes responsibility and ownership they can positively influence and motivate the rest of the team to integrate the standards into practice and improve the quality of MSK care provided. Ensuring that the named lead for the standards feeds back to the team on what data is collected and what is being audited is also important.’

Mark Knight-Davis, consultant MSK physiotherapist, Anuerin Bevin University Health Board

‘There are certain standards that can be implemented rapidly in our service and considered “quick wins”, in particular emphasis on shared decision making in standard 2. 

‘Shared decision-making has been adopted during the last three to four years across our service with a training programme supporting implementation and so this standard would be the first we would implement and measure. This would show value of the standards and boost morale for the team.’ 

CSP assistant director Sue Hayward-Giles: 

‘This first set of MSK service standards, with the audit tool, will provide organisations, clinicians, patients and commissioners with a clear framework on which to set service expectations and measure good practice. 

‘Given the pace of change that the pandemic has driven I expect the standards to also support services to assess what change to consolidate and identify the quality improvement required.’

Lead author of the standards Dr Annette Bishop:

‘These standards have been developed with an expert working group and through wide consultation with stakeholders.

They draw on high level evidence to create the first MSK physiotherapy services standards. The plain English version has been co-produced with people with a lived experience of MSK conditions. The standards and audit tool will provide organisations, clinicians, patients and commissioners with standards of care which should be met for MSK care in the UK and measure markers of good practice. 

‘I hope services will use them as a tool to demonstrate the value of MSK physiotherapy as well as for identifying areas for quality improvement. I also hope patients and the public will have a greater understanding of what constitutes quality MSK physiotherapy. The aim is for these standards and audit tool to be beneficial for services wanting to measure and compare their services in ways that are agreed by a variety of stakeholders and I hope they prove to be valuable tools.’