Sport and exercise medicine in NHS England: the pathways of sport-related injury patients and social costs

This thesis explores the general public s experiences of sport related injury (SRI) as they utilise Sport and Exercise Medicine services in NHS England. It focuses specifically on: the treatment pathways to, and utilisation of, one Sport and Exercise Medicine (SEM) clinic in NHS England; the social and economic costs incurred as a consequence of SRI; and the extent healthcare utilisation and costs coalesce to structure SRI experience. The study employs a qualitative methodology based on a two phase research design that retrospectively maps the pathways of patients (n=19) up until their treatment at the SEM clinic (focusing on social and economic costs ), and prospectively, as a number of patients (n=4) continue their treatment at the SEM clinic, thus illustrating how pathways and costs feed each other in problematic ways. Findings demonstrate that patient pathways to SEM are relatively lengthy and inefficient due to a lack of knowledge of SEM initiatives for SRI treatment amongst both GPs and patients. This leads to indirect referrals, increased workload in primary care and the utilisation of general orthopaedic secondary care services. It further highlights a number of social and economic costs incurred through SRI, such as diminished social wellbeing, increased emotional labour, poor health behaviours and workplace absenteeism, which are exacerbated through inefficient patient pathways and patient dissatisfaction with general orthopaedic treatment. The thesis is the first study to shed light on the pathways of SRI patients in the NHS and the treatment experience of SEM clinics in NHS England. It demonstrates the extent SEM initiatives justified on the basis of improving the efficiency of pathways and satisfaction of treatment for SRI patients could be more effectively implemented and identifies a number of important implications for the future sustainability of physical activity health promotion policy and the wider social and economic productivity of exercising public populations.