Integrated primary and community support for people living with chronic pain, musculoskeletal problems and mental health conditions
People living with chronic pain, musculoskeletal conditions and mental health problems often experience fragmented care. This rapid evidence review explores how integrated, person-centred primary and community care can better support their physical, psychological and social needs.
This rapid evidence review examines how primary and community care can better support people living with chronic pain, musculoskeletal conditions and mental health problems.
Drawing on 134 studies and community engagement workshops, it identifies the key features of effective integrated care and sets out recommendations for national organisations, local decision-makers, workforce planning and system leaders.
Executive summary
People with coexisting musculoskeletal (MSK) conditions, chronic pain and mental health (MH) problems represent one of the largest, most unequal, and least well-served populations with long-term illness in England. Global Burden of Disease (GBD) data indicates that MSK conditions and MH problems account for around half of all years lived with disability in England, a proportion that has continued to rise over the past three decades. In England, chronic pain affects approximately one quarter of adults, with higher prevalence, greater severity and poorer outcomes in more deprived communities. Around 40% of people living with chronic pain also experience anxiety or depression.
Despite this substantial and growing burden, care for people living with MSK conditions, chronic pain and MH problems remains fragmented. The NHS continues to be largely organised around single‑condition speciality-based models, with pain services, MSK services, and MH services tending to operate in parallel rather than in partnership. As a result, patients frequently attend multiple appointments with little integration across services, which can result in a biomedical approach to care, dominated by medication rather than integrated, holistic person-centred care. These issues disproportionately affect underserved communities, compounding health and care inequalities.
This rapid evidence review explores models of primary and community care to support adults living with MSK conditions, chronic pain and MH problems. The review synthesised evidence from systematic reviews and primary studies using a prioritisation framework. In addition, it was supplemented by two community engagement workshops with people with lived experience, clinicians and voluntary sector organisations in East London and North East England.
What the evidence shows
Based on a review of 134 studies, supported by community workshops, we found that:
Effective care is biopsychosocial, person-centred and multi-component
The strongest and most consistent finding across the evidence base is that integrated approaches addressing physical, psychological and social needs are more effective than single-component or biomedical models. Biopsychosocial approaches are more likely to improve pain, functioning, mental wellbeing and reduce reliance on medication. Supported self-management is a central mechanism that helps people live well with pain.
Integration depends on how services are organised
Effective models are multi-component with multidisciplinary team (MDT) working, complemented by group sessions, peer support and medicines optimisation. Partnering with community organisations to help address the wider social determinants of health is important. There are now emerging examples of community-led pain management services.
Workforce capability is critical to delivery
Delivering integrated care requires a workforce with the skills to provide psychologically-informed and person-centred care. Evidence supports expanded and hybrid roles, including care managers, physiotherapists trained in psychological approaches, and MH professionals embedded within MSK and pain pathways. There is evidence that training staff leads to improved knowledge and confidence, but the impact on patient outcomes is uncertain.
Policy and system implications
Current NHS policy emphasises integration, neighbourhood-based care and multidisciplinary working. The findings of this review are strongly aligned with this direction. However, there remains a significant gap between policy ambition and the reality of service delivery.
Community engagement identified persistent barriers to services: poor interoperability of electronic patient records, organisational silos, rigid referral pathways, and limited trust between services. These structural issues often result in patients being passed between services, with responsibility for coordination falling on individuals who may have the least capacity to manage it.
At the same time, the potential role of community and peer-led support is not fully realised. While the formal evidence base is limited, these approaches are relatively low-cost and highly valued by patients, suggesting that they should be incorporated into service models alongside clinical care.
Declarations
This Evidence Brief has been commissioned by the Getting It Right First Time (GIRFT) team at NHS England to support their statutory responsibility, with funding from the Joint Work and Health Directorate (Department for Work and Pensions and Department of Health and Social Care). Policy interventions beyond health care services were not in scope. The views expressed in this publication are those of the author(s) and not necessarily those of NHS England, Department of Health and Social Care.
Acknowledgements
We would like to thank the Live Well with Pain group, Durham University, and Bromley by Bow Health Centre for hosting and helping to organise the community workshops.