Commissioning Sport and Exercise Medicine Services: A Strategic Guide for Healthcare Leaders
In today’s healthcare landscape, where demand continues to outpace resources, the need for innovative, cost-effective solutions has never been greater. Sport and Exercise Medicine (SEM) offers a compelling answer. By focusing on musculoskeletal health, physical activity, and long-term condition management, SEM services can significantly improve patient outcomes while easing pressure on secondary care.
But commissioning SEM services requires more than clinical enthusiasm; it demands strategic planning, stakeholder engagement, and a clear demonstration of value. Drawing on the experience of Dr. James Hopkinson, a consultant in SEM and seasoned healthcare leader, this guide outlines a practical approach to commissioning SEM services that are both impactful and sustainable.
Establishing Value in a Financially Constrained System
At the heart of any commissioning decision lies the question of value. For SEM services, this means demonstrating that improved patient outcomes can be achieved without exceeding financial constraints. As Dr. Hopkinson explains, value is best understood as the ratio of outcomes to cost. Commissioners must be able to show that SEM services can deliver measurable improvements, such as reduced waiting times, fewer hospital referrals, and enhanced patient satisfaction, within a defined budget.
This is particularly important in the current climate, where many Integrated Care Boards (ICBs) are operating under significant financial pressure. New services must either be cost-neutral or offer clear savings elsewhere in the system. Identifying opportunities to reallocate existing resources or reduce inefficiencies is often key to unlocking funding.
Understanding local needs and context
No two healthcare systems are identical, and successful SEM commissioning begins with a deep understanding of the local landscape. This includes identifying gaps in current provision, understanding patient demographics, and mapping existing services. Engaging with local trusts, primary care networks, and community providers can help build a comprehensive picture of where SEM can add the most value.
Dr. Hopkinson emphasises the importance of tailoring services to local needs rather than adopting a one-size-fits-all model. In some areas, this might mean focusing on musculoskeletal triage; in others, it could involve developing exercise referral pathways for patients with chronic conditions.
Designing Services for Integration and Impact
SEM services are most effective when they are integrated into broader care pathways. Rather than operating in isolation, they should complement and enhance existing services. For example, SEM clinicians can work alongside physiotherapists, orthopaedic teams, and general practitioners to streamline patient journeys and reduce duplication.
One successful model, implemented in Nottingham, involved the creation of a community-based musculoskeletal pathway. This approach allowed patients to be assessed and managed closer to home, reducing unnecessary hospital referrals and improving access to care. The result was not only better outcomes for patients but also significant cost savings for the system.
Building Stakeholder support
Introducing a new service inevitably involves change, and change can be met with resistance. Existing providers may feel threatened, or commissioners may be wary of investing in unproven models. Overcoming these challenges requires proactive engagement.
Identifying champions, such as clinicians, managers or patient representatives who support SEM, can help build momentum. Equally important is listening to concerns and involving sceptics in the design process. Transparency, collaboration and a shared focus on patient benefit are essential to building trust and securing buy-in.
Making the financial case
Even the most clinically compelling service will struggle to gain traction without a robust financial case. Commissioners need to see clear, evidence-based projections of costs and benefits. This includes not only direct costs such as staffing and facilities but also potential savings from reduced imaging, fewer referrals, and improved long-term health outcomes.
Starting small can be a wise strategy. Piloting a service in one locality or patient group allows for real-world evaluation and provides the data needed to support wider rollout. Demonstrating early success can be a powerful tool in securing ongoing investment.
Aligning with broader strategies
To maximise impact and sustainability, SEM services should align with local and national health strategies. This includes priorities around reducing health inequalities, promoting physical activity, and managing long-term conditions in the community. By positioning SEM as a solution to these broader challenges, commissioners can strengthen the case for investment and integration.
Looking to the future
The potential of SEM extends far beyond musculoskeletal care. With its focus on prevention, rehabilitation, and lifestyle medicine, SEM is uniquely positioned to address many of the most pressing health challenges of our time. However, realising this potential requires long-term thinking and a willingness to invest in services that may not deliver immediate returns but offer substantial benefits over time.
As Dr. Hopkinson notes, “We need to think beyond the next financial year. SEM is about keeping people well, not just treating them when they’re sick.”
Conclusion
Commissioning SEM services is both a challenge and an opportunity. It requires careful planning, strong partnerships, and a clear focus on value. But for those willing to invest the time and effort, the rewards are significant: healthier populations, more efficient services, and a healthcare system better equipped to meet the demands of the future.