Community Assessment Days: Bringing care into the community across Leicestershire

Trailblazed by musculoskeletal (MSK) physiotherapists in 2023 with the aim to de-medicalise care by moving from hospital to community and, crucially, having conversations instead of consultations. CADs are centered around the simple concept of understanding what matters most to someone, then working alongside them to make that happen.

MSK conditions affect over 20 million people in the UK each year, up to 30 per cent of GP consultations in England are for MSK conditions. Waiting lists for MSK community services are high in England, at around 350,000 people in September 2024 (348,799) – the highest of all community service waiting lists. 

In Leicestershire, Leicester and Rutland (LLR) one in five residents are living with an MSK condition. Waiting lists for MSK community services within LLR were among the highest in the country, with only 53 per cent of patients within the area’s largest acute trust seen within 18 weeks (Jan 2025). 

MSK ill health is also the second largest contributor to economic inactivity amongst the local working age population.

NHS Leicester, Leicestershire and Rutland Integrated Care Board (ICB) were selected as one of 17 Places, to manage the Getting it Right First Time (GiRFT) MSK Community Delivery Programme funded by the Joint Work and Heath Directorate (DWP/DHSC).

The focus of the GiRFT Community MSK workstream is to reduce waiting times for a community MSK appointment; to improve access to MSK treatment and support people back to work. Working collaboratively with Leicestershire Partnership NHS (LPT), University Hospitals of Leicester NHS Trust (UHL), Active Together, Leicestershire County Council, Hinckley and Bosworth Borough Council, Charnwood Borough Council, Places Leisure, Fusion Lifestyle and local charity and voluntary sector organisations, CAD’s are a vital part of the delivery programme. 

This novel integrated model of care brings together people seeking support, clinical expertise, voluntary sector services and the wider community under one roof. CAD’s allow people to engage with multiple services in one visit and importantly leave having received all the support they need.  

Most people attend a CAD because they might have chronic knee pain however, because the format focuses on patient centered conversations, you might discover someone needs housing support, debt management advice, a conversation about their mental health and their blood pressure checked. Ordinarily, that might be five different appointments spread over several weeks. During a CAD, people can access all these services in the Community Village within a couple of hours truly demonstrating a new integrated model of care” 

Andrew Harris at Active Together highlights the importance of accessing multiple services. 

• To date, two CAD’s have supported approximately 300 people throughout LLR.

• Over 50 per cent of people invited for a clinical MSK physiotherapy appointment were subsequently removed from a community MSK waiting list having received the care they required.

• Over 100 people have been signposted to a range of ‘self-management’ physical activity interventions including ESCAPE-pain, Steady Steps and Leisure Centre services.

• Twenty-three people signposted to their GP due to undiagnosed high blood pressure.

• CAD’s have contributed to an overall reduction in local community MSK waiting lists. One acute trust reporting 85 per cent of people are now seen within 18 weeks (September 2025)

Further CAD’s are planned for 2026 within Leicester City. These will be codesigned to support people from lower socio-economic groups and ethnic diverse communities who are more likely to experience higher levels of health inequalities. 

There is already positive momentum, and local stakeholders firmly believe the concept of CAD’s as a long term ‘best buy’. CAD’s are in keeping with the NHS 10 Year Health Plan, particularly the movement from hospital to community. Furthermore, this work aligns well with the National Neighbourhood Health Implementation Programme, bringing care closer to where people live. Leicestershire West being one of 43 Places initially selected to set up a new Neighbourhood Health Service.

A formal cost benefit analysis is a local ambition to further leverage the acceptability of CAD’s to support a robust business case for further investment.

• CAD’s have increased visibility and strengthened relationships with local health, wellbeing and care services for the public and professionals.

• There are opportunities for further improvement in operational execution and data collection to support more comprehensive evaluations.

• As CAD’s become more targeted within our more deprived and culturally diverse communities the need to collaborate with locally trusted Organisations will be critical to ensure they are successful.

• Overall, based on the available evidence, CAD’s have demonstrated positive impacts on patient self-management and staff engagement. 

Andrew Harris  [email protected]

Links to relevant documents: 

• ESCAPE-pain is an education and exercise programme for people with chronic joint pain or osteoarthritis.
   
• Steady Steps is a free postural stability exercise programme.
   
• Community Assessment Days allow residents with local community partners, charities and other specialist community services.