Digital self-management and self-referral for musculoskeletal complaints in London

Common musculoskeletal (MSK) conditions often do not need specific or specialist treatment and may resolve if people follow simple, evidence-based advice.

Digital technology can provide immediate day-to-day support while connecting people to their local MSK pathway and support services across an integrated care system (ICS). By using technology, people can access trusted, evidence-based advice in a consistent and standardised way.

Situation

Patients lack appropriate digital resources to actively self-manage their condition.

Also, waiting times to see a clinician can be long.

Aspiration

Using digital technology to provide immediate day-to-day support whilst connecting people to their local MSK pathway and support services across an ICS. It has the potential to deliver trusted, evidence-based advice in a consistent and standardised way.

Solution and impact

South West London Health and Care Partnership used getUBetter, a MSK self-management app , for patients with common MSK injuries and conditions.

getUBetter provides digital self-management support across the entire care pathway. This helps patients:

• trust their recovery
• manage their condition
• use fewer healthcare resources

getUBetter is available at all GP practices, physiotherapy services and from some A&E departments.

getUBetter can be accessed through patients on their own or prescribed during a consultation by:

• GPs
• first contact physiotherapists
• nurse practitioners
• non-clinical staff

It can also be used by physiotherapy providers to support waiting lists.

getUBetter can be provided wherever a patient interacts with the system. This could be a self-referral or in:

• primary care
• minor injury units
• A&E
• physiotherapy
• secondary care

getUBetter promotes safe self-management.

It also automates referrals for treatment appropriately.

getUBetter is at level C of the NICE Digital Health Technology Evaluation Framework.

The app has recognised techniques to change behaviours and maximise impact.

Functionality

getUBetter is an app that can be used on a number of devices.

• It’s suitable for all common new, recurrent and long-term MSK injuries and conditions.
• The app provides self-management advice.
• It features video exercises.
• Patients receive advice on what to do if their symptoms get worse and where to get help.
• The app gives users advice when to seek further help.
• Users can connect to their local health service.
• Users have access to local public health, social care, and third-party support.
• The app makes automated referrals.
• Clinicians receive updates through medical records.
  

Capabilities

getUBetter:

• supports the entire care pathway
• supports remote healthcare
• has a symptom tracker
• includes stratification and outcome measures to guide patients
• has safety netting
• virtually connects users with a healthcare practitioner
• promotes behaviour change
• promotes self-management
• reduces healthcare utilisation
• lets patients access local self-management clinics
• includes an end-to-end integrated care pathway
• can refer users back into the system when needed
• can be prescribed or people can refer themselves
• lets patients manage their progression at their own pace
• helps users access and directly book local treatments such as physiotherapy and wellbeing services

Scope

• No patient should have to wait for access to local self-management support.
• getUBetter is provided at the first opportunity.
• Local MSK self-management support is available 24 hours a day, every day of the year.
• Easily accessible, targeted and personalised self-management information to help patients day-to-day and step by step.
• Exercises based on patient’s stage of recovery and the ability to self-progress.
• Reassurance and support to self-manage.
• Supports recovery, prevention, and re-occurrence.
• Standardised care.

Key figures/quotes

• For every £1 spent, getUBetter saves £4.20.
• Reduces physiotherapy referrals by 20%.
• Reduces GP appointments by 13% (Wanless B., McClellan C., 2019).
• There was a 50% reduction in prescribed medication for MSK conditions.
• getUBetter demonstrated behaviour change.
• Early data shows 66% reduction in A&E attendances.
• ORCHA review results are 91% in 2021 to 2022.

Patients reported:

• an improved ability to self-manage
• an improved confidence to self-manage
• a better understanding of their condition and recovery

86% of patients would recommend to family and friends. 73% felt the app would provide a better GP service (none disagreed). 100% of patients felt the app would help recovery.

Clinician feedback

“I think it is a fantastic resource on its own but also because patients can then be referred on through the Wandsworth pathway directly”.
Dr Ali Hassas, GP, Wandsworth

“We see the ever-expanding app as a major part of our service redesign going forward”.
Jim Fenwick, CEO, Battersea Healthcare

Find out more

Academic paper on a tailored app for the self-management of MSK conditions

getUBetter case study from the Health Innovation Network South London

Key contact

Ben Wanless, consultant MSK physiotherapist, St George's University Hospital NHS Foundation Trust

benwanless@nhs.net

Carey McClellan, clinical director, getUBetter

contact@getubetter.com