Through primary care
As specialists with a generalist approach to musculoskeletal care and a willingness to work as part of a multidisciplinary team, SEM physicians are perfectly placed to work in community settings alongside GPs, physiotherapists, podiatrists and other specialists. Clinical commissioning groups (CCGs) can commission services that include SEM physicians in clinical assessment and treatment services (CATS), working in community venues with access by self-referral or GP referral. The generalist nature of SEM physicians facilitates their presence in multispecialty community providers outlined in the NHS Five Year Forward View working alongside primary care. GPs can also refer direct to secondary care musculoskeletal services where SEM physicians are part of a multidisciplinary department.
Currently there are SEM primary care services in only a few areas of England including the North East, Essex and London. These are at an early stage of development but we expect to see a slow expansion over the next 10 years.
Through secondary and tertiary care
Many people with acute sports injuries initially attend minor injury units or emergency departments. The SEM department can receive direct referrals from emergency care (in a similar way to fracture clinics) or work directly alongside emergency care staff. Chronic sports injuries and non-inflammatory musculoskeletal problems, which have traditionally been seen by orthopaedic surgeons and rheumatologists, can be treated by SEM physicians who can offer an alternative strategy to management. Being part of the musculoskeletal service within a hospital the SEM department needs to work closely with the rheumatology, orthopaedic and physiotherapy departments. Triaging and cross referrals can then be optimised. This will enhance the effectiveness of treating this large patient group and improve the patient journey.
There are SEM secondary and tertiary care services in Bath, Birmingham, Cambridge, Hampshire, Leicester, London, Nottingham, Oxford, Sheffield and Teesside in various stages of development.