Improving access to MSK services in primary care: How applying quality improvement methodology can optimise the implementation of remote consultations


To explore how implementing remote digital consultations can improve service provision of the Musculoskeletal First Contact Practitioner service in primary care. Catalysed by the current Coronavirus pandemic this service evaluation project was initially designed as a result of quality improvement (QI) analysis. Having scrutinised our current service using quality improvement methodology (QIM) several root cause problems that impeded access to the service were identified. Specifically, a paucity in the use of digital technology/remote consulting was apparent.


A comprehensive root cause analysis of the service using tools such as process mapping identified the possible ways to improve access and efficiency across the FCP pathway. A driver diagram explored the various factors related to implementing remote consultations and identified the key change ideas. Implementing these changes was analysed systematically with PDSA cycles at each stage of change.


Results: The application of QIM in this project helped identify poignant aspects to the project design and implementation. Initially it helped justify the value of the project and later (using PDSA cycles) analysis identified emerging problems, allowing them to bee addressed promptly. This meant the service was able to focus on ‘quick wins’ regarding the operational change such as messaging functions to provide patients with safety netting advice. Initial quality improvement analysis revealed common themes amongst clinicians and patients regarding the potential for incorrect diagnosis, missing serious pathology and safeguarding issues. Similarly, there were concerns regarding the ability to perform some important objective tests. Positive trends were observed regarding patient satisfaction, with high initial scores on the Likert scale in all early analysis. College satisfaction was also noted to be generally high and provided vital feedback throughout the process.

Conclusion(s): Through applying QIM the FCP service was able to implement remote consultations as an alterative to traditional face to face consultations. This on-going process helped the service achieve this efficiently but ensured patient safety was central to future transformation, whilst conjunctively involving stakeholders throughout. QIM can be and effective model in optimising service change and encourages a fluid approach to monitoring it. This also helps facilitate rapid changes in uncertain situations such as the coronavirus pandemic

Cost and savings

Increased access to service although enough significant statistical data has not yet been gathered.


The project identifies how QIM can be a powerful tool in guiding service change. This project sets out the priorities for ongoing quality improvement evaluation of remote consultations in MSK FCP services

Top three learning points

No further information. 

Funding acknowledgements