In late February the UK government announced the introduction of a new ‘sport and exercise medicine doctor’ qualification. This move, several years in the making, will remodel the way sports medicine is practised in the UK. The template is Scandinavian, and health officials in the US, Australasia and Europe, facing similar social, demographic and public health pressures, will no doubt be watching the UK’s progress with interest.
What follows is a short report drawn largely from interviews with two leading players in the UK sport and exercise medicine field, Professor Mark Batt, consultant in sport and exercise medicine at the Queen’s Medical Centre in Nottingham, who chaired the official SEM working group; and Dr Rod Jaques, medical director of the English Institute of Sport.
The February announcement from the Department of Health heralded a ‘new breed of doctors… helping to keep the nation on target to be fit, healthy and active’. It went on: ‘The National Health Service doctors will not only treat sports injuries but also help prevent injuries… Everyone from reluctant keep-fitters to the nation’s Olympic team will have access to the doctors, who will work not only in hospitals but also with schools, community groups and professional sports clubs.’
There are two big health pressures coming together here, which are common to all western societies. The first is the lifestyle diseases/healthy living agenda, in which our do-less and eat-more habits are stoking up an intolerable level of demand on the health service to manage epidemics of heart disease, cancer, obesity, diabetes and so on.
The second pressure, paradoxically, is that sports and activity-related injuries are themselves a significant and growing burden. While there is no shortage of expertise in putting broken bones and damaged joints back together, effective handling of softtissue injuries is far less satisfactory. The Department of Health says there are 700,000 sports-related emergency hospital admissions a year; and it has long been recognised that the poor level of NHS rehab and aftercare creates its own destructive socioeconomic legacy in the form, for instance, of chronic back pain and low level disability.
Mark Batt explains: ‘We’ve been far too blasé about dealing with the injuries and illnesses that result from people being physically active. It’s not acceptable to have a builder who is also a rugby player who tears his knee ligaments and then can’t work on a construction site any more… We need to get these people back, fit and well again at work and paying taxes, not unable to work, or worse still on disability because of a neglected injury.’
The government’s health agenda dovetails well with the professional aims of the small but growing band of specialist sports medicine physicians who have been lobbying for proper recognition of their specialty. The new SEM qualification gives them that recognition, quality assured through a new medical ‘faculty’.
As the structure of UK medical training is undergoing a major shakeup, it is not possible to indicate exactly how the training and career path for SEM doctors will work. But it will be a four-year training, and for the moment, Mark Batt says, ‘It’s very likely we’ll take candidates who already have a primary qualification, and, given the numbers likely to apply, a masters or diploma in sport and exercise medicine will almost certainly also be an entry criterion.’
After qualifying, SEM doctors could find themselves going in several different directions. Rod Jaques says: ‘I can see four types of people practising SEM: NHS consultants in multi-disciplinary teams; private specialists in private teams; some GPs on an ‘associate specialist’ basis, going out for two or three sessions a week to the local hospital and working in outpatient departments, then bringing those skills back to their own practices; and those working with top-level sportsmen and women.’
Jaques foresees the impact being felt less at the elite level than further down: ‘A significant proportion of the full-time SEM doctors currently working in the UK are already involved in institutes of sport and in professional sport like the Premiership football and rugby clubs. At the top end the standard of care is already high. The people who are most going to benefit in terms of serious sportsmen are that very substantial tier below this, who in 10 years’ time will be very much better catered for in NHS and private practice.’
At the other end of the scale – provided the public health service puts up the cash of course – SEM doctors will also be recruited to take up the cause of healthy living among the least sporty and active people in society. Batt explains: ‘You can draw parallels looking to the Netherlands and Finland, where they have SEM doctors and have a much better record in terms of healthy living and mortality statistics related to heart disease, stroke, diabetes and so on.’
Both Batt and Jaques stress that they envisage SEM doctors working as part of cross-disciplinary care teams. Batt says: ‘The training will not be three years of osteopathy or physiotherapy and a year of medicine. We understand and want to work with people that have complementary skills. We’re not going to train people to mimic other professions already in existence.’
Jaques concurs: ‘To be a proper sports injury clinic you need doctors, musculoskeletal radiologists, sports physios, strength and conditioning coaches and massage therapists as a bare minimum. That should be a basic template. To work in an isolated fashion I think dilutes the ability to diagnose and treat people correctly.’
Pen Robinson, director of Member Networks and Relations for the Society of Chartered Physiotherapists, says the consultation document on SEM was not very strong on multi-disciplinary working across professions. ‘Let’s hope they are talking properly about collaborative working,’ she says. ‘We need to keep a weather eye on it.’
In general, Robinson says of the SEM announcement: ‘It is formalising what is already going on to an extent, and adding, rightly, to raising the profile for the requirements of exercise and sport in the UK… However, there are a lot of roles in respect of this area. It is highly unlikely that the sports medicine consultant will actually carry out treatment – that is much more likely to be carried out by physiotherapists and others. The only problem is that if we are talking about increasing patient choice and selfreferrals, it might put a barrier between the patient and the treatment.’
The UK has, by Rod Jaques’ estimate, no more than about 30 fulltime sports medicine physicians at the moment. This group is likely to be accredited early with the new SEM title, perhaps as soon as next year. Thereafter the rate at which SEM doctors graduate depends on the training cash put up by the health service and the number of suitable work placements that can be created either in the UK or elsewhere in the EU, for a large pool of potential recruits. And on the threshold of this belated but welcome new era in medicine, Jaques predicts that public need will more than justify the creation of the new breed: ‘I hope that, in 10 to 15 years’ time, sports and exercise medicine doctors in the NHS will not be too few for the population they are trying to serve.’