Frequently over the past few months I have become aware of many issues that I feel, as a service user I take for granted or at least have not given much consideration to. Being part of the Musculoskeletal Integration Project in the northern part of Staffordshire has offered me so much more than just the opportunity to have a say as a lived experience patient.

Encouraged to consider so many issues and comment accordingly is one side of this exciting role; the other side is being able to learn more about the whole NHS world and impart that learning outside the organisation.

One of the workstreams I have mentioned before in the integration project is the Workforce Development programme. The project leads and contributors have so much to consider but I have always been encouraged to seek clarification wherever necessary.

A recent meeting saw the function and process of triage being discussed and how, for instance Advanced Physiotherapy Practitioners have to allocate their time. This has opened my eyes, widely. While 80% of their time is engaged in expert clinical practice, the other 20% is engaged in research and evaluation, training and education plus leadership activities. All of these facets are needed to keep abreast of developments and be up-to-date at all times in order to offer the best possible care.

Also within that 20% of their time is the need to carry out their triage duties. That is to examine and decide the courses of action necessary from referrals received from primary care. Have I ever had the knowledge of these issues before? No! I can now appreciate far more of the ‘hand springs and cartwheels’ and the ‘hoops to jump through’ that our clinical practitioners have to navigate. Did I need to sit in on very important and far reaching development programmes to understand this? Probably not, but having the opportunity to do so as part of my role objectives has been a privilege. The commitment and dedication our clinical practitioners exhibit every day is something I feel we should all be mindful of and appreciate.

So from one topic to another, but no less interesting and important is the commissioning process; something else I was not too familiar with and probably never gave it a second thought. Until now. In numerous meetings and conversations I have come to learn so much more about this topic too. Possibly the most onerous task for commissioners is to please everybody all of the time. No less onerous a task is for service providers to grapple with the challenges and idiosyncrasies that commissioning processes place before them.

I can only align my thoughts to MSK services at the moment. I often reflect at the end of each meeting I am invited to and internally vocalise, “I’m glad I don’t have to make that decision”. The number of examples I could cite is legion and perhaps one day I will produce a list of the challenges, but the often quoted “post code lottery” most certainly seems to exist, but maybe with some justification. I am sure a room full of commissioners, service providers and service users would have innumerable reasons to challenge each other. I am hoping to add my voice to challenge the status quo.

What has been, quite simply the most fulfilling of my Peer Support role and the vast number of opportunities to represent the patient groups is the extent to which service transformers, service restorers and service practitioners – clinical and administrative alike – are considering ‘patients front and centre’. Never a day goes by, no project and study with which I am engaged and no ‘gold standard’ aspiration is anything other than patient focused. It is often the case that the service gets a raw deal, but from my privileged position it is often unfounded. And that is not a privileged person speaking from the inner sanctum; it is a patient who needs to let the wider health community know how we are always at the centre of the plans. Appointment booking staff, Health Care Assistants, practitioners from all disciplines have our interests at heart. I, for one, salute you!

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