To support healthcare professionals in the early diagnosis and management of arthritis, the National Institute for Health and Care Excellence has published expert guidance for both rheumatoid arthritis and osteoarthritis, which are available at the following links:

https://www.nice.org.uk/guidance/ng100

https://www.nice.org.uk/guidance/ng226

The Royal College of General Practitioners also has a range of e-learning materials to support general practitioners (GPs) and other primary care professionals in the diagnosis and management of arthritis, including a rheumatoid arthritis hub and an osteoarthritis hub.

We are supporting better care for patients with arthritis through the Getting It Right First Time Programme (GIRFT) for Rheumatology. The GIRFT rheumatology programme is supporting the National Health Service to deliver care more equitably across England and closer to patients’ homes, and improve services nationally.

To support people with musculoskeletal (MSK) conditions, we are working to deliver the GIRFT MSK Community Delivery Programme. GIRFT teams are working directly with health system leaders to reduce MSK community waiting lists, including for people with arthritis, and support the recovery, long-term transformation and ongoing delivery of high-quality accessible community MSK services.

As part of a major transformation of the NHS under the 10-Year Health Plan, patients with MSK conditions will also soon be able to directly access community services, including physiotherapy, pain management and orthopaedics, in the NHS App. The landmark change will deliver faster treatment for the flare up of existing conditions including arthritis, backpain and joint pain, while enabling GPs to focus on more complex cases, reducing pressure on hospitals and freeing up GP practices.

The Government is taking action to improve outcomes for people with MSK conditions. This includes through working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to reduce community MSK waiting lists, which are the highest of all community waiting lists in England, and transform community services to support people with MSK conditions.

As part of a major transformation of the National Health Service under the 10-Year Health Plan, patients with MSK conditions will also soon be able to directly access community services, including physiotherapy, pain management, and orthopaedics, in the NHS App. The landmark change will deliver faster treatment for the flare up of existing conditions including arthritis, backpain, and joint pain, while enabling general practitioners (GPs) to focus on more complex cases, reducing pressure on hospitals, and freeing up GPs.

The Government remains committed to improving outcomes for people living with rare diseases, including inclusion body myositis and other rare progressive muscle disorders, through the UK Rare Diseases Framework and successive England Rare Diseases Action Plans. Increasing awareness among healthcare professionals is one of the framework’s four priorities.

As set out in the 2026 England Rare Diseases Action Plan, NHS England continues to expand rare disease education through the National Genomics Education Programme, including GeNotes, a clinical resource that now covers more than 150 rare diseases and has been integrated into primary care decision-support tools used by general practitioners. NHS England is also developing resources to support healthcare professionals in having sensitive conversations with patients receiving a rare disease diagnosis, while the Genomics Training Academy provides education and training to the specialist genomics workforce.

These initiatives support earlier recognition, diagnosis, and appropriate management of rare conditions.

The latest data available from 2025/2026 shows that the average wait time from the point of requesting a magnetic resonance imaging (MRI) test to receipt of a scan is 41.5 days for all MRI scans, and 36.1 days for musculoskeletal (MSK) related issues for Luton residents. The average wait time is not collected from the point of general practice (GP) referral as referrals would not normally be directed from GPs.

The National Institute for Clinical Excellence guidance recommends that patients with MSK conditions do not have imaging requested by a non-specialist service unless serious underlying pathology is suspected. This means that MRI scans or other imaging should be requested by an MSK service, or other specialist service, and not by a GP unless there is significant, life-threatening, or urgent medical disease or condition, for instance cancer, spinal infection, organ failure, or a fracture.

NHS England publishes data on diagnostic waiting times, including the proportion of patients waiting six weeks or more for diagnostic tests such as MRI scans.

We are committed to improving access to diagnostics and have expanded capacity through community diagnostic centres, which are delivering additional MRI and other tests closer to patients’ homes and helping to reduce waiting times.

The Department funds research through the National Institute for Health and Care Research (NIHR). The NIHR funds clinical, public health, and social care research and works in partnership with the National Health Service, universities, local government, other research funders, patients, and the public, and also funds global health research. NIHR funding is not typically ringfenced for specific conditions. Instead, research proposals are assessed through an open, competitive peer review, with funding decisions made on the basis of scientific quality, the importance of the research question to patients and health and care services, and value for money. This approach ensures that the strongest proposals with the greatest potential impact are supported.

In this disease area over the last five financial years, from 2020/21 to 2024/25, the Department committed £40.4 million on new research projects alongside supporting infrastructure into inclusion body myositis and other rare progressive muscle disorders. This has included clinical trials and novel therapies at NIHR clinical research facilities and NIHR biomedical research centres looking at gene silencing, micro-dystrophin, and disease-modifying therapies for neuromuscular condition.

The NIHR’s Be Part of Research allows people to find and take part in health and care research, and shows that there are currently eight studies where researchers are actively looking for participants in several aspects of muscle disorders. Further information on Be Part of Research is available at the following link:

https://bepartofresearch.nihr.ac.uk/

Data is fundamental to the effective delivery of health services, underpinning service improvement and ultimately improving outcomes for patients.

Musculoskeletal (MSK) data for secondary care, including orthopaedics, spinal services, paediatric orthopaedics, and adult and paediatric rheumatology are regularly reviewed by the NHS England Getting It Right First Time (GIRFT) specialty programmes in NHS England, and work is undertaken with hospitals and within NHS England to make improvements where they are identified.

The Joint Work and Health Directorate is also funding GIRFT to deliver the MSK Community Delivery Programme, which aims to improve MSK community services, reduce waiting lists, improve outcomes, and address health-related barriers to work.

The programme has a focus on strengthening MSK leadership, improving data recording and submission, supporting digitally enabled services, and using data and benchmarking to drive performance improvement.

The standard of training for doctors is the responsibility of the General Medical Council (GMC). The GMC sets the outcome standards expected at undergraduate level, and approves courses and medical schools to write and teach the curricula content that enables their students to meet these standards.

The curricula for postgraduate training are set by the Academy of Medical Royal Colleges for foundation training, and by the relevant individual royal colleges and faculties for specialty training. The GMC approves curricula and assessment systems for each training programme.

Whilst not all curricula necessarily highlight a specific condition, they all emphasise the skills and approaches that a doctor must develop in order to ensure accurate and timely diagnoses and treatment plans for their patients.

Curricula across the specialties where doctors in training might regularly treat patients with musculoskeletal conditions will contain competencies relating to understanding and identifying these conditions and their symptoms.

The Government recognises the impact that delays in diagnostic imaging can have on patients, particularly those in severe pain or unable to work.

We are taking a range of steps to improve access to imaging, including expanding capacity through community diagnostic centres (CDCs). Magnetic resonance imaging (MRI) is a core test within CDCs and at present we have 143 MRIs in 125 sites that provide it, having delivered nearly 2.9 million MRI tests since 2021. We have also funded new MRI scanners to increase access and availability to MRI scanning.

We are also supporting the National Health Service to increase workforce capacity, make better use of existing diagnostic equipment, and prioritise patients based on clinical need. These measures are helping to reduce waiting times and ensure patients with the most urgent needs are seen as quickly as possible.

To support people with musculoskeletal (MSK) conditions more broadly, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to reduce community MSK waiting lists. Patients with MSK conditions will also soon be able to directly access community services, including physiotherapy, pain management, and orthopaedics, in the NHS App. The landmark change will deliver faster treatment for the flare up of existing conditions, including arthritis, backpain, and joint pain.

We know that continuity of care is important, particularly for people with long term conditions. Integrated care boards (ICBs) are responsible for commissioning the significant majority of health services within the National Health Service for their local population, which includes a wide range of services, such as community, elective and outpatient care, within which musculoskeletal (MSK) services are typically planned and delivered.

Information on waiting times for MSK services is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/community-health-services-waiting-lists/

To tackle waiting lists, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to reduce community MSK waiting lists and transform community services to support people with MSK conditions.

As was reaffirmed in the 10-Year Health Plan, we are also committed to continue using independent sector capacity to improve access and reduce backlogs.

ICBs, as healthcare commissioners, are responsible for ensuring value for money is achieved through their contracts with providers. Provider procurement must take place within the rules of the provider selection regime, a flexible and proportionate process for selecting providers of healthcare services so that all decisions can be made with a view to securing the needs of the people who use the services, improving the quality of the services and improving the efficiency of service provision.

We know that continuity of care is important, particularly for people with long term conditions. Integrated care boards (ICBs) are responsible for commissioning the significant majority of health services within the National Health Service for their local population, which includes a wide range of services, such as community, elective and outpatient care, within which musculoskeletal (MSK) services are typically planned and delivered.

Information on waiting times for MSK services is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/community-health-services-waiting-lists/

To tackle waiting lists, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to reduce community MSK waiting lists and transform community services to support people with MSK conditions.

As was reaffirmed in the 10-Year Health Plan, we are also committed to continue using independent sector capacity to improve access and reduce backlogs.

ICBs, as healthcare commissioners, are responsible for ensuring value for money is achieved through their contracts with providers. Provider procurement must take place within the rules of the provider selection regime, a flexible and proportionate process for selecting providers of healthcare services so that all decisions can be made with a view to securing the needs of the people who use the services, improving the quality of the services and improving the efficiency of service provision.

We know that continuity of care is important, particularly for people with long term conditions. Integrated care boards (ICBs) are responsible for commissioning the significant majority of health services within the National Health Service for their local population, which includes a wide range of services, such as community, elective and outpatient care, within which musculoskeletal (MSK) services are typically planned and delivered.

Information on waiting times for MSK services is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/community-health-services-waiting-lists/

To tackle waiting lists, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to reduce community MSK waiting lists and transform community services to support people with MSK conditions.

As was reaffirmed in the 10-Year Health Plan, we are also committed to continue using independent sector capacity to improve access and reduce backlogs.

ICBs, as healthcare commissioners, are responsible for ensuring value for money is achieved through their contracts with providers. Provider procurement must take place within the rules of the provider selection regime, a flexible and proportionate process for selecting providers of healthcare services so that all decisions can be made with a view to securing the needs of the people who use the services, improving the quality of the services and improving the efficiency of service provision.

We know that continuity of care is important, particularly for people with long term conditions. Integrated care boards (ICBs) are responsible for commissioning the significant majority of health services within the National Health Service for their local population, which includes a wide range of services, such as community, elective and outpatient care, within which musculoskeletal (MSK) services are typically planned and delivered.

Information on waiting times for MSK services is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/community-health-services-waiting-lists/

To tackle waiting lists, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to reduce community MSK waiting lists and transform community services to support people with MSK conditions.

As was reaffirmed in the 10-Year Health Plan, we are also committed to continue using independent sector capacity to improve access and reduce backlogs.

ICBs, as healthcare commissioners, are responsible for ensuring value for money is achieved through their contracts with providers. Provider procurement must take place within the rules of the provider selection regime, a flexible and proportionate process for selecting providers of healthcare services so that all decisions can be made with a view to securing the needs of the people who use the services, improving the quality of the services and improving the efficiency of service provision.

We are committed to returning by March 2029 to the National Health Service constitutional standard that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment, across all specialties, including trauma and orthopaedics. In March 2026, we hit our first interim target of 65% performance against that standard.

In the last year, Hampshire Hospitals NHS Foundation Trust, the provider located in the Eastleigh constituency, has seen a 5.4% increase in the proportion of waits under 18 weeks and a 6.9% increase in trauma and orthopaedics, the specialism that covers joint replacement surgery.

The Department is taking a range of steps to reduce waiting times for surgery, including joint replacement surgery. There are currently 125 surgical hubs operational across England, and we are committed to expanding the number of hubs over the next three years to increase surgical capacity and deliver faster access to common procedures. In addition, the Getting it Right First Time (GIRFT) programme is supporting improvements by publishing detailed guidance for hip and knee replacements in June 2023 and leading a community musculoskeletal (MSK) programme to support improvements in the early stages of MSK pathways, so that only those who require surgery are referred into secondary care. Further information on the GIRFT programme is available at the following link:

https://gettingitrightfirsttime.co.uk/

The information requested is not readily available and to provide it would incur disproportionate cost.

The Somerset NHS Foundation Trust, which runs Yeovil Hospital, is commissioned to provide all National Institute for Health and Care Excellence-approved biological medicines for arthritis, which, when used in appropriate patients, produce substantial clinical improvements.

The rheumatology department is a multi-disciplinary team of doctors, specialist nurses, physiotherapists, radiographers, occupational therapists, and administrative staff. Patients can be referred by their general practice (GP) teams for diagnosis, treatment and, when appropriate, long-term management of patients with a range of musculoskeletal (MSK) disorders, including inflammatory arthritis, soft tissue rheumatism, osteoarthritis, connective tissue diseases, and osteoporosis. Clinics run in Yeovil, Taunton, and at a number of community hospitals, depending on the condition.

NHS Somerset has a self-referral based MSK condition app, the getUBetter app, that helps provide support and exercises to patients with minor MSK conditions and complaints, and which includes support on returning work.

The Orthopaedic Assessment Service in Somerset provides a specialist opinion for patients who have an orthopedic or MSK problem where treatment by their GP, physiotherapist, or podiatrist has not managed the symptoms and where further assessment is required.

In England, the organisation and delivery of multidisciplinary care for patients with hypermobile Ehlers-Danlos syndromes (hEDS) and associated co-morbidities is a matter for local National Health Service systems. Integrated care boards are responsible for commissioning services to meet the needs of their populations, including access to relevant specialties such as rheumatology, neurology, pain management, and, where appropriate, neurosurgical services, with decisions about referrals and coordination of care made by clinicians, based on individual patient need and the available evidence. Multidisciplinary team working is an established part of NHS practice for patients with complex needs.

The Department has made no specific national assessment of the adequacy of care pathways for people with hEDS and associated co‑morbidities. There is currently no single nationally defined care pathway or service specification specific to hEDS or related co- morbidities. Clinical management is guided by existing evidence, relevant National Institute for Health and Care Excellence guidance where available, and the clinical judgement of specialist teams. The Government continues to support improvements in care for people with complex conditions through wider initiatives, such as the 10-Year Health Plan and Getting it Right First Time programme.

Diagnostic investigations for suspected craniocervical instability, including magnetic resonance imaging (MRI) and computed tomography, are available through existing NHS pathways. Access to more specialised imaging, such as upright or dynamic MRI, is determined locally and used in limited circumstances based on clinical need. There are no current plans to expand national provision.

Responsibility for education and training sits with healthcare professionals themselves and with NHS England, which leads workforce planning and supports continuing professional development. Clinicians are expected to keep their knowledge up to date, drawing on national guidance, research evidence, and professional resources relevant to their role.

To support people with musculoskeletal (MSK) and back pain conditions, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to further reduce MSK community waiting times, which are the highest of all community waits, and to improve data, metrics, and referral pathways to wider support services.

In the Old Bexley and Sidcup constituency, those seeking support for MSK conditions and back pain conditions can access services such as the Bexley MSK Service, which provides specialist care for adults in the Bexley area experiencing a wide range of MSK conditions and which offers personalised treatment plans tailored to individual needs. Launched in Summer 2025, the getUBetter app, commissioned by the NHS South East London Integrated Care Board, is also accessible to Bexley residents aged 16 years old or over and those registered with a Bexley general practice. It offers information on local services, including self-referral options for leisure activities supporting health and wellbeing.

NHS England does not nationally commission chiropractic care as it is a complementary and alternative medicine. Integrated care boards can make independent decisions on which health professionals they employ and may commission a limited amount of such treatment.

The Neighbourhood Health Framework is designed to provide clarity and consistency to integrated care boards (ICBs), local authorities, and their partners, in developing and scaling neighbourhood health.

The framework outlines the national minimum aims and objectives of Neighbourhood Health Services. This includes improving health outcomes with specific focus on high-priority cohorts, including people with frailty. Whilst frailty and musculoskeletal overlap, we recognise that many people with conditions affecting their joints, bones, and muscles across their life course are not frail.

It is important that reforms are locally led, as ICBs and local authorities are best placed to design services that make sense for their local populations. Local systems can choose to go further than the minimum aims set out in the framework, and this could include musculoskeletal services.

We know there are areas where we need to go further. Delivering a Neighbourhood Health Service will be an incremental process as local understanding develops and national reforms progress.

The Government is committed to supporting disabled people and people with health conditions, including back pain and musculoskeletal (MSK) conditions, with their employment journey. We therefore have a range of specialist initiatives to support individuals to stay in work and get back into work, including support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants, as well as Connect to Work and WorkWell.

As well as supporting people back into work, it is important that they are supported to successfully remain there. The Keep Britain Working review, published in November 2025, examined how employers can support healthier and more inclusive workplaces. Sir Charlie Mayfield was appointed to work in partnership with DWP, DBT and DHSC to oversee the implementation of his recommendations. Over 120 employers and ten regions are working with us through employer-led vanguard sprints, reshaping how health and disability are managed at work.

Musculoskeletal (MSK) problems were one of the leading causes of sickness absence in the UK in 2024. Early detection and prevention, including increasing access to employment advice, can support people with MSK conditions getting into and remaining in work.

The Government is committed to supporting disabled people and people with health conditions, including those with back pain and MSK conditions, with their employment journey. We therefore have a range of specialist initiatives to support individuals to stay in work and get back into work, including support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants, as well as Connect to Work and WorkWell.

As well as supporting people back into work, it is important that they are supported to successfully remain there. The Keep Britain Working review, published in November 2025, examined how employers can support healthier and more inclusive workplaces. Sir Charlie Mayfield was appointed to work in partnership with DWP, DBT and DHSC to oversee the implementation of his recommendations. Over 120 employers and ten regions are working with us through employer-led vanguard sprints, reshaping how health and disability are managed at work.