Consultant physicians working with patients - Royal College of ...

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2 Specialties Sport and exercise medicineSport and exercise medicineWilby Williamson MRCP MSc(SEM) Dip(SEM)Academic clinical fellow, sport and exercise medicineGraeme Wilkes MRCP MRCGP MSc(SEM) FFSEMConsultant, sport and exercise medicine1 Description of the specialtySport and exercise medicine (SEM) as a speciality hastwo objectives:1 Address the needs of physically active groups andkeep them active2 Contribute to primary and secondary diseaseprevention by promoting and increasing physicalactivity participation.Addressing the needs of physically active groups coversa broad spectrum of practice that is not exclusive tosports people and recreational athletes. SEM practicecrosses the lifespan, treating children and adolescentswith musculoskeletal complaints that preventparticipation in school activities and hobbies through toolder adults with decline in mobility. Occupationallybased SEM practice helps adults to remain in activejobs, such as members of the armed services, publicsector, construction industries, agriculture and otherlabour-intensive jobs, by managing musculoskeletalcomplaints. Clinical practice relating to sport andstructured exercise addresses the clinical needs of the15–25% of the UK population that regularly participatein sport and structured activity. 1 This clinical practiceranges from offering sports injury clinics to workingwith local, national and international sports teams ininjury prevention and management.Sedentary behaviour and inactivity are majorcontributors to musculoskeletal disease, reducedwellbeing and cardiovascular morbidity/mortality. Theburden of physical inactivity extends across diseasegroups and impacts on society throughout our lifespan.Physical inactivity contributes to 5.3 million deathsworld-wide and is recognised by the World HealthOrganization as one of the five most significant riskfactors for chronic disease and reduced life expectancy. 2Physical activity is integral to healthy growth anddevelopment yet, in the UK, only 70% of 10 year oldsand less than 30% of 15 year olds achieve physicalactivity guidelines of 60 minutes of moderate tovigorous activity per day. 3 Inactivity and sedentarybehaviour continue to increase across the lifespan, withless than 8% of older adults engaging in the adultrecommended levels of 150 minutes of moderate tovigorous activity per week. 3 SEM consultants workingin physical activity promotion undertake roles inenvironments ranging from primary prevention inpopulation and community interventions to secondaryprevention in lifestyle behaviour clinics and chronicdisease management.To meet the broad demands of clinical practice SEMconsultants undergo 6 years of specialist trainingpost-foundation training. SEM speciality trainingcovers chronic diseases, exercise physiology, publichealth medicine, acute and emergency medicine,general practice, musculoskeletal and team medicine,as well as solid grounding in education, teaching andresearch.2 Organisation of the service and patternsof referralInvestment in sport and exercise medicine andimproving equity in public access to SEM services are ofpressing national importance. The expansion anddevelopment of SEM services to date have largelyevolved around the efforts of proactive, innovative andindustrious individuals at regional levels. To dateinvestment by NHS commissioners on behalf of theirpatients has been low. Sporadic regional developmentof service continues to support the bulk of NHSpractice.Regional efforts are now being supported by the NationalCentre for Sports and Exercise Medicine, based on threesites. The National Centre is a partnership betweenhospital trusts and universities from London, Sheffieldand the East Midlands. The Department of Health hasprovided capital funding to help develop three facilities,C○ Royal College of Physicians 2013 251
Consultant physicians working with patientsone in each partner group, to speed up the translationof research into clinical practice. The funding ofthe National Centre is part of the government’s Olympiclegacy commitment, post-London 2012. It is anticipatedthat the National Centre will lead research and developmentto improve non-surgical musculoskeletal care andmusculoskeletal disease prevention. It will also work toestablish physical activity behavioural medicine services,particularly for those with chronic long-term conditions,many of whom could benefit from the expert prescriptionof exercise as part of their treatment. The NationalCentre for Sports and Exercise Medicine is a collaborativeinitiative with regional members. The regionaldevelopment of SEM outside these centres continuesto grow.The clinical roles undertaken by SEM physicians leadsto work in a variety of environments and manyconsultants would describe having portfolio careers. Asa specialty in the process of being established, regionalframeworks of clinical practice and organisationalstructure continue to evolve. Clinical practice can bebroadly grouped as community models of practice andsecondary care models.Community models of careIn a community setting, SEM consultants are workingwith commissioners to develop locally agreedprotocols/pathways in order to facilitate effectivephysical activity prescription within primary care andprompt access to appropriate musculoskeletal care.In community musculoskeletal clinics, SEMconsultants: provide a specialist opinion for patients andhealthcare professionals close to the patient’s home introduce a unique skill set, including the use ofdiagnostic ultrasound and guided injectiontherapies, which expedites the diagnosis andmanagement of musculoskeletal problems provide support for other primary healthcareprofessionals, such as extended-scopephysiotherapists (ESPs) and general practitionerswith a specialist interest (GPwSIs) introduce a formal system of continuingprofessional development (CPD) and appraisal forphysicians working within musculoskeletal services contribute to more efficient use of NHS funds forpatients with musculoskeletal pathology throughcarefully considered and managed non-surgicalplans in partnership with physiotherapists.In chronic disease management promoting physicalactivity to achieve primary and secondary riskreduction, consultants working in community practiceundertake roles defined by local resources and physicalactivity initiatives. Practice might include individualpatient consultations with clinical risk assessments,physical activity measurement and behaviouralmodelling with outcome assessment at follow-up.Alternatively it might include physical activity servicesdevelopment, creating triage systems that are sensitiveto individual patient needs, coordinating localresources and establishing sustainable behaviouralinterventions.Models of secondary careIn secondary care, SEM consultants work withinmultidisciplinary teams and complement and expandcare options across: adult musculoskeletal services,musculoskeletal adolescent care, pain managementand chronic disease programmes. SEMconsultants: lead musculoskeletal and sports injuries clinics,alongside existing orthopaedic, physiotherapy andemergency department services, providingdiagnosis, treatment and rehabilitation ofnon-surgical musculoskeletal (including back pain),soft-tissue and sports injuries establish chronic disease rehabilitation schemes thatare patient centred rather than disease centred andavailable to all, irrespective of morbidity provide a specialist service including clinical exercisetesting and risk assessment for patients with moreextensive or severe chronic disease andcomorbidities provide a specialist service including clinical exercisetesting to aid preoperative anaesthetic riskassessment provide an ongoing educational programme onevidence-based and effective exercise prescriptionfor teams working in specific chronic diseaseareas.3 Working with patients: patient-centredcareSEM services are centred on the patient and providenew options for healthcare providers in specialistexercise and musculoskeletal referrals. Patient choice isan important feature of these services, providingalternative options for patients. Many services areavailable in the community, close to home.252 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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