The publication of the Neighbourhood Health Framework marks an important step in the NHS’s long-term direction of travel, with clear emphasis on the benefits of prevention, earlier intervention and care delivered closer to home. This shift reflects a growing recognition that a system largely focused on treating illness once it becomes acute is neither sustainable nor delivering the best outcomes for patients. Yet, if this model is to succeed in practice, it requires us to look more closely at how different types of need are currently prioritised and where gaps remain.
Nowhere is this more apparent than in musculoskeletal (MSK) care. Over 20 million people in the UK, around one third of the population, are living with an MSK condition (NHS England) and these conditions are the second leading cause of long-term work sickness (ONS). Despite this scale and impact, they continue to sit outside the core of urgent decision-making. The tension, as I see it, is that clinicians are highly effective at identifying and responding to life-threatening conditions, but less consistent in approaching those that are life-altering. If neighbourhood health is to deliver meaningful change, that distinction needs closer examination. Because it’s in that gap that many patients with MSK conditions are currently being left behind.
Defining serious illness in a life-threatening versus life-altering approach to care
In day-to-day clinical practice, prioritisation is unavoidable. GPs in particular are constantly balancing competing demands, making decisions under time pressure about what requires immediate action and what can be managed over time. Within this context, MSK conditions often fall into the latter category. They’re rarely life-threatening, can appear non-specific and are frequently approached as problems to be monitored or managed conservatively.
However, this framing can obscure the lived reality for patients. The individual presenting with back pain may not be in immediate danger, but they may have been struggling for months – perhaps being unable to sleep properly, finding it difficult to perform at work, gradually withdrawing from activities that were once routine. And that’s the point where, as clinicians, we start to see things shift.
What’s often described clinically as ‘non-serious’ can, from the patient’s perspective, feel extremely serious. MSK conditions are rarely isolated to just physical complaints. They’re closely linked to mental health, social participation and economic stability. This is where the distinction between life-threatening and life-altering becomes more than a semantic one. It shapes how patients are prioritised, how quickly they’re able to access care, and ultimately, the trajectory of their condition. When we rely too heavily on a model of urgency that’s defined primarily by immediate clinical risk, we risk missing how much these conditions build over time – worsening more gradually, but no less significantly.
Timing is everything for effective MSK care
One of the most important factors in good MSK care is timing and it’s also one of the most challenging aspects of the current system. On paper, the pathway is logical – patients are assessed, serious pathology is excluded and they’re directed towards appropriate follow-up care. In practice, however, the time between those steps can be considerable and it’s during that period that conditions evolve.
"I recently treated a patient who’d spent over a year navigating this process. By the time he arrived at my clinic his initial complaint (lower back pain) was now part of a much more complex picture. He’d experienced intermittent periods out of work, financial pressure was mounting and his confidence in his ability to return to normal activity had diminished significantly."
This is a pattern that will be familiar to many GPs. In the early stages of an MSK condition, most patients are motivated to recover. They want to remain in work, maintain their routines and return to normal function as quickly as possible. However, as delays extend, that mindset can shift. Reduced activity leads to deconditioning, uncertainty leads to fear of movement and the longer someone is absent from work, the more difficult that return becomes.
From both a clinical and economic perspective, this really matters. MSK conditions are already a leading cause of lost working days in the UK, with millions of days lost each year. What’s often overlooked in these discussions is that capacity does exist to intervene earlier. Chiropractic care, for example, could provide at least 100,000 additional appointments annually, with estimated productivity gains of at least £400 million through supporting people back to work more quickly (BCA, Health Economics Report, 2025).
So, in looking at MSK conditions specifically in this context of earlier intervention, the challenge becomes not necessarily one of resource, but of how that resource is understood, accessed and better integrated into care pathways. In other words, it’s not just about what’s available, but about how quickly patients can actually get to it.
A neighbourhood approach in practice, not just in principle
The NHS Neighbourhood Health Framework places strong emphasis on care delivered closer to home, with a more integrated and collaborative approach across services. In many ways, this reflects what is already happening informally in MSK care, where patients often navigate between different providers in search of relief. However, this process is rarely coordinated, and access is not always equitable.
Chiropractors are part of a regulated healthcare workforce, trained to assess, diagnose and manage MSK conditions and to refer when necessary. They’re already embedded in communities across the UK, often acting as a first point of contact for patients who have either experienced delays within NHS pathways or who have chosen to seek care independently.
Despite this, their role within the wider system remains inconsistently recognised. For GPs, this creates a practical challenge. Faced with increasing demand and constrained pathways, there’s limited visibility of how regulated healthcare professions, like chiropractic can be incorporated into patient care. Yet where collaborative approaches do exist, where GPs, physiotherapists and chiropractors work alongside one another, the benefits are evident. Patients are able to access care more quickly, treatment can be tailored more effectively, and the burden on any single part of the system is reduced.
"This is not a new concept. In professional sport, for example, multidisciplinary teams are standard practice, with each professional contributing their expertise to support recovery and performance."
The same principle can be applied more broadly within community healthcare, particularly in areas such as MSK, where conditions are multifactorial and responses to treatment vary between individuals.
If neighbourhood health is to move from principle to practice, it will require more explicit recognition of the full range of skills and services already available within communities. It will also require confidence among clinicians, particularly in primary care, to make use of those options where appropriate, supported by clearer pathways and shared understanding.
Conclusion – widening how we think about need
"One case that has stayed with me for years involved a patient repeatedly admitted to hospital with suspected cardiac symptoms – severe chest pain and breathlessness, yet normal test results. By the time she came to see me, she was living with significant anxiety alongside the physical symptoms – she had even rewritten her will. The cause was musculoskeletal, and once treated, her pain improved quickly, along with the sense of uncertainty she had been carrying."
Cases like this are a reminder that how a condition is classified clinically does not always reflect how it’s experienced by the patient, or the impact it can have if left unaddressed. This gap is where many MSK conditions currently sit within the system.
If the Neighbourhood Health Framework is to deliver on its ambition of earlier intervention and more integrated, community-based care, then we need to apply that same thinking more consistently to MSK health. In practical terms, that requires:
- A broader definition of urgency, recognising life-altering conditions alongside life-threatening ones
- Earlier access to MSK care specialists, to prevent avoidable escalation and long-term absence from work
- Better use of the existing regulated workforce, including chiropractors already embedded in communities
- Greater awareness and confidence in referral and signposting options across primary care
My call to action here is not about shifting focus away from acute care, but about preventing avoidable decline before it becomes harder, and more costly, to reverse. For a significant proportion of patients, neighbourhood health will only succeed if MSK care is fully part of that conversation, rather than sitting just outside of it.