Musculoskeletal (MSK) conditions are problems that affect the bones, muscles and other soft tissues in the body (such as tendons and ligaments).

What has happened so far?

The project team has conducted a range of engagement and insight gathering activities. This is to better understand the current situation in Dorset, and to learn how other parts of the country have improved the same service. These activities include:

  • Gathering existing insight
  • Conducting a view seeking survey
  • Speaking to patients who had experienced challenges in accessing services
  • Visiting special interest groups
  • Engaging with services that have implemented alternative models

The information below explains more about each stage of the review so far.

Stage 1: Looking at what services are available now and what is needed

We looked at the demand and use of services in Dorset and aimed to identify any trends that need to be considered. This is called the data and needs analysis.

The team also researched what is working well in other areas of the country.  For example, in some areas, there are ‘self-referral’ to physiotherapy services and First Contact MSK Practitioners in GP surgeries. These models are being delivered in various places across the UK, as well as on an ad-hoc basis in pockets of Dorset.

Existing insight was collected from a number of sources:

  • Outcomes of the Physiotherapy Review conducted in 2014
  • Patient feedback collected from providers (Friends & Family Test; Complaints & Compliments)
  • A literature review of best practice and evidence for alternative models of access to services

Stage 2: View Seeking

We designed a survey, in partnership with Bournemouth University, to gather views from patients, carers and staff about what is working well and what could be improved.

The focus of the review is on access to physiotherapy services, and the pathway through physiotherapy services. The survey asked a) what is working well and b) what could be improved.  It was available online and in paper. The review team and partners to the review shared the online questionnaire widely.  In addition, the review team attended some physiotherapy clinics, meeting and listening to people’s views and experiences.

The survey closed on the 1 July 2018. It was hosted by Bournemouth University’s Market Research Group (MRG), who were responsible for collecting and analysing responses and providing a report to summarise the outcomes. See the report here.

Survey respondents were invited to register their interest in joining a Reference Group that would be involved in shaping the improvements to the service.

Stage 3: Developing options

The third stage was to develop options for how physiotherapy services could look.

A co-production team was made up of the people who signed up to be part of the reference group after completing the online survey, along with professionals who work in physiotherapy.

This co-production team attended three sessions where they helped to design improvements for the service in the future.

Following the third and final reference group meeting, the second version of the draft service delivery options were emailed to the whole reference group membership list (as not all members were able to attend the reference group).  The aim was to further refine the options prior to voting.  A lot of comprehensive feedback was received from professionals, patients and carers and will be very helpful in developing some of the detail around how the services will be delivered.  The draft options were updated again following this feedback.

The final process was to send out the final options paper to the reference group membership and put an article in the GP Bulletin to ask for votes on the preferred options.  Votes were received from 45 people, including 15 GPs and 6 patients/carers.  The remainder of votes were from professionals working in physiotherapy services, and other professionals such as Public Health.

What happens now?

In February 2019, the review team presented a proposal based on the voting results to the Clinical Reference Group where it was approved.

The recommendations in the proposal included:

  • Self-management – Developing a website with standard information about services, common MSK conditions and self-help advice.
  • Self-referral – The option for people to refer themselves via telephone and the website.

Work has now started on the development of a business case to enable the delivery of these recommendations.

Also, since the review took place, the NHS Long Term Plan was published. The Long Term Plan included the introduction of a First Contact Practitioner role in Primary Care Networks from 2020/2021.  First Contact Practitioners (sometimes referred to as Advanced Practice Physiotherapists) have advanced skills to assess, diagnose, treat and manage MSK problems. This is a positive step to improve the MSK Physiotherapy pathway for patients.

We are about to bring providers back together as a Task and Finish Group to lead on this work.

We will keep this webpage updated and if you have any questions in the meantime please contact us at

Thank you to everyone who took part in this survey and to those who attended the reference group sessions. Your input has helped to improve this vital and valuable service.

In the meantime, please look at Feedback Bulletin for any other involvement opportunities that you might be interested in.