Community Appointment Days versus Standard Physiotherapy for People with a Musculoskeletal Condition

One in three people live with a musculoskeletal condition affecting their muscles, bones, or joints. These conditions can cause pain, reduced mobility, time away from work, and increased risk of other health problems such as heart disease. The NHS currently spends an estimated £6.3 billion each year on musculoskeletal conditions. While physiotherapy can improve outcomes, waiting lists are long and current services often focus only on the immediate referral rather than the wider health and social care needs people may experience.

Community Appointment Days aim to address this challenge by bringing care closer to communities. Delivered in accessible non-medical settings such as leisure centres, CADs offer assessment, rehabilitation, advice, health promotion, and support from social care, local councils, and the voluntary sector in a single place. Originally developed by Laura Finucane and the team at Here (Care Unbound Ltd), the model has expanded nationally following strong patient satisfaction and evidence suggesting shorter waiting lists and more joined-up care.

Despite this promise, important questions remain about whether CADs improve outcomes for people with musculoskeletal conditions and whether they represent the best use of NHS resources. The new research programme will provide the first large-scale evaluation of the model.

The study will compare CADs with standard care across 20 UK locations, with 10 sites delivering Community Appointment Days and 10 continuing standard care. Allocation will be randomised to ensure a fair comparison. Researchers will examine impacts on health-related quality of life, healthcare costs, access to care, attendance at appointments, ongoing engagement with services, waiting times, and environmental sustainability.

Alongside the clinical trial, the team will conduct interviews and group discussions with patients, healthcare professionals, commissioners, and delivery partners to understand what works well, what challenges remain, and how CADs could be implemented effectively and equitably across different communities.

The project is led by the Bone & Joint Health research group at the Blizard Institute, part of Queen Mary University of London, working closely with the Pragmatic Clinical Trials Unit. Professor Antonia Liguori will contribute her internationally recognised expertise in digital storytelling to help capture patient and stakeholder experiences and better inform future implementation of Community Appointment Days across diverse communities and healthcare settings.