The new Community MSK guidance: Is this the NHS future we’ve been waiting for?

By Dr Ollie Hart

The publication of this week’s NHS England Community MSK Service Specification felt genuinely significant to me, for two reasons.

Firstly, it explicitly states that community MSK services should use “evidence-based interventions such as peer support, self-management education and health coaching to support self-management.” That is a landmark moment for those of us who have spent years arguing that these approaches belong in mainstream NHS care, not at its margins.

But the second reason is even more exciting...

For me, this is one of the clearest descriptions yet of what the NHS actually means when it talks about moving from a “doing to” service towards a “doing with” service.

For years we’ve heard about the three shifts at the heart of the NHS 10 Year Plan—from hospital to community, from sickness to prevention, and from analogue to digital. Few would disagree with the ambition, but I’ve often found myself wondering: what does that actually look like in practice?

As someone who has worked as a GP, a PCN Clinical Director and now trains health coaches across the NHS and beyond, I’ve sometimes felt that national policy agreed with the principles of personalised care, but service specifications still described a predominantly biomedical model. We knew where we wanted to go, but not always how we would get there.

Reading this specification felt different. For the first time, I found myself thinking, “Yes… this is what we’ve been trying to build.” Rather than simply describing treatments, it describes a way of working: health coaching, supported self-management, shared decision making, understanding what matters to people, building confidence, helping people remain in work and connecting care across neighbourhoods. These are not presented as optional extras; they are woven into the fabric of how modern community MSK services should operate.

It’s no surprise that these ideas appear together. Health coaching, peer support, shared decision making and personalised care are all practical expressions of the same philosophy: enabling people rather than simply treating them.

I know the GIRFT MSK and Chronic Pain team have spent years listening to services around the country and looking carefully at what works. Perhaps that explains why they have become one of the first national programmes to operationalise so much of the wider NHS vision for neighbourhood health.

Publishing a specification is only the beginning.

The document also says that staff should demonstrate competence in personalised care approaches and behaviour change techniques, and that they should feel “well-supervised and supported to innovate, reflect and learn”, backed by a continuing professional development strategy.

Those sentences matter, because this isn’t simply about introducing health coaching. It’s about developing a workforce that has the skills, confidence and support to work differently. Health coaching isn’t something people absorb after a short training course. It requires practice, reflection, supervision and, above all, a genuine shift in mindset.

The specification also recognises the importance of connecting with health and wellbeing coaches, social prescribing, voluntary organisations and WorkWell employment support. That feels like another important signal. If we are serious about neighbourhood health, then relationships across organisations become just as important as the pathways within them.

This is not more of the same with a few personalised-care additions. It feels like a genuine shift in thinking, and an invitation to design services differently.

Interestingly, this echoes themes from The King’s Fund’s recent conference on the future of neighbourhood health, where the emphasis was on moving from doing to communities towards doing with them through partnership, trust and shared capability.

I hope this proves to be the start of something much bigger. If this approach can be embedded successfully in MSK services, perhaps it won’t be long before similar thinking shapes guidance across many other long-term conditions.