TOPLINE

Among patients with non-inflammatory musculoskeletal pain, adjusting for patient characteristics changed the rankings of several of the 13 primary care networks in one English region based on musculoskeletal outcomes, with variation observed in patient-reported musculoskeletal health. The adjusted proportion of patients prescribed an opioid within 2 weeks of a consultation varied across networks and according to socioeconomic deprivation.

METHODOLOGY

• Researchers conducted a prospective cohort study to assess variation in musculoskeletal outcomes and consultation experience as well as the rates of opioid prescribing across primary care networks in England.
• They included 1875 adult patients with non-inflammatory musculoskeletal pain (mean age, 57.7 years; 66% women) who visited 30 general practices within 13 networks between September 2021 and July 2022. Of these patients, 46% had experienced 10 or more prior episodes of musculoskeletal pain.
• Musculoskeletal health was assessed at baseline and at 3 months using the Musculoskeletal Health Questionnaire, a patient-reported measure with scores ranging from 0 to 56; higher scores indicated better health.
• A change in the questionnaire-based musculoskeletal health score at 3 months served as the primary outcome; consultation experience reported by patients and receipt of an opioid prescription within 2 weeks of the consultation were secondary outcomes.
• Primary care network-level variation in the quality of musculoskeletal care was assessed using funnel plots, with case-mix adjustments for age, employment status, the baseline musculoskeletal health score, pain duration, and other factors. Benchmarks were set using the Achievable Benchmark of Care method, drawing on the performance of the top-performing networks.

TAKEAWAY

• Overall, 70% of the patients completed the survey immediately after consultation and during follow-up at 3 months. Patients' mean musculoskeletal health scores increased from 25.3 at baseline to 30.2 after 3 months; after adjustment, the weighted mean gain was 4.8 points (gains ranged from 3.0 to 5.7 points).
• The benchmark for improvement in the musculoskeletal health score was 5.7 points; three networks met this benchmark, achieving improvements that exceeded the clinically meaningful change of 5.5 points.
• The adjusted share of patients prescribed an opioid within 2 weeks of the consultation varied between 13.7% and 36.8% across networks (benchmark, 19.6%); two networks had adjusted opioid-prescribing levels above the 95% control limit for high prescribing.
• After adjustment, mean 3-month musculoskeletal health scores were 26.9 among patients in the most deprived quintile vs 31.3 among patients in the less deprived quintiles; poor consultation experience and opioid prescribing were also more common among the most deprived patients than among the less deprived patients, affecting 7.4% vs 4.6% and 31.0% vs 26.0% of patients, respectively.

IN PRACTICE

"Case-mix-adjusted benchmarking of MSK [musculoskeletal] outcomes and prescribing in English primary care is feasible. Across 13 PCNs [primary care networks], average 3-month MSK-HQ [Musculoskeletal Health Questionnaire] improvement was modest and variation persisted for consultation experience and opioid prescribing after adjustment. We present this as a proof of principle for the method rather than as an assessment of the participating networks," the authors wrote.

SOURCE

The study was led by Jonathan C. Hill of the School of Medicine at Keele University, in Newcastle-under-Lyme, England. It was published online on October 9, 2026, in BMJ Open.

LIMITATIONS

Follow-up lasted only 3 months, possibly limiting the assessment of recovery over a longer period. Only 14.9% of the invited patients responded at baseline, and response rates differed across networks; therefore, some differences between networks may have reflected who took part rather than the care provided. Minimal ethnic variation affects the applicability of the findings to more diverse populations. 

DISCLOSURES

The study was supported by the Nuffield Foundation's Oliver Bird Fund and Arthritis UK. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.