Establishing a Sport and Exercise Medicine Service: A Practical Guide for NHS Integration

Introduction

Delivering a successful Sport and Exercise Medicine (SEM) service within the NHS requires more than clinical expertise. It demands strategic insight, stakeholder engagement, and a deep understanding of the local healthcare landscape. Drawing on the experience of Dr. James Hopkinson, this guide outlines the essential steps and considerations for setting up a sustainable and impactful SEM service.

Understanding Local Needs and Context

The foundation of any SEM service must be a clear understanding of the local healthcare environment. This includes:

• Assessing existing MSK and physical activity services.
• Identifying service gaps and unmet patient needs.
• Understanding local commissioning priorities and financial constraints.

Rather than imposing a predefined model, SEM services should be tailored to complement and enhance what is already in place.

Engaging Stakeholders early

Building strong relationships is critical. Key stakeholders include:

• Integrated Care Boards (ICBs), particularly MSK commissioning leads.
• Local NHS trusts and community providers.
• Allied health professionals, including physiotherapists and GPs with Extended Roles.
• Orthopaedic and rheumatology departments.

It is equally important to identify potential allies and those who may feel threatened by the new service. Open dialogue and collaboration can help mitigate resistance and foster shared ownership.

Demonstrating Value and Sustainability

Commissioners will expect evidence of both clinical and financial value. A robust business case should include:

• Clear service outcomes, such as reduced waiting times and improved patient access.
• Quantifiable metrics: patient volumes, cost savings, and efficiency gains.
• Integration strategies that avoid duplication and demonstrate system-wide benefits.

Financial resilience is also essential. Partnering with established providers can offer the necessary infrastructure and credibility to secure contracts and manage risk.

Designing the Service Model

A successful SEM service is rarely standalone. Instead, it should integrate with existing care pathways and offer:

• Specialist MSK assessment and triage.
• Physical activity interventions across specialties (e.g. cardiology, respiratory, neurology).
• Support for long-term condition management and rehabilitation.
• Education and leadership within multidisciplinary teams.

Where possible, align with existing programmes such as cardiac rehab or pulmonary rehabilitation to enhance reach and impact.

Navigating Commissioning and Procurement

Understanding the commissioning cycle is vital. Engage early with ICBs to:

• Identify commissioning timelines and strategic priorities.
• Explore opportunities for co-design or pilot programmes.
• Position SEM as a solution to current system pressures, not an additional cost.

Conclusion

Setting up an SEM service within the NHS is a complex but rewarding endeavour. By aligning with local needs, engaging stakeholders, and demonstrating clear value, SEM consultants can lead the development of services that improve outcomes, reduce costs, and support the NHS’s long-term vision for integrated, preventative care.