Editorial Staff , 2025-07-28 13:02:00
By helping patients manage their condition in the community, the programme not only improves lives but is aligned with the Sláintecare principles of right place, right time, right person
Osteoarthritis is one of the leading causes of disability in Ireland, particularly among adults aged 50 years and older. Joint stiffness, pain, difficulty with functional activities, weight gain due to reduced mobility and work absenteeism are common consequences.
To date, timely access to first line intervention such as exercise, education and advice on diet has been very limited within the community setting, resulting in patients waiting for prolonged periods on an acute hospital Outpatient Waiting List.
The National Clinical Programme for Trauma and Orthopaedic Surgery in collaboration with the HSE’s Modernised Care Pathways programme have been testing an integrated care pathway aimed at managing patients who present to their GPs with mild to moderate symptoms of osteoarthritis (OA).
For the project period (April 2023 – March 2025), 1,856 patients have been managed via this pathway, with 66 (3.5 per cent) requiring an OPD appointment with an orthopaedic consultant and 18 (<1 per cent) patients required surgery.
This service re-design is currently being tested on two sites – Our Lady’s Hospital, Navan and University Hospital Waterford/Carlow/Kilkenny with funding being secured through the Sláintecare Integration Innovation Fund (SIIF).
With the implementation of this new integrated care pathway, patients are referred by their GP to a clinical specialist physiotherapist in the community. Following a comprehensive assessment, patients are offered personalised exercise plans, education on OA and nutrition advice provided by a dietitian. Hospital referrals are now made only when absolutely necessary.
The national clinical programme has developed an APP that is available to all patients participating in this project which encourages self-management over time.
Patient Initiated Review and access to local sports facilities are all available to patients via the APP which is available via the HSE’s APP store.
A different way to treat a common problem
“We used to see a high volume of referrals straight to orthopaedic consultants,” explains Mr Alan Walsh, Consultant Orthopaedic Surgeon. “But the truth is, most patients don’t need surgery. What they need is support, guidance on exercise, diet, and how to manage their condition. This programme is about getting the right care, in the right place, at the right time.”
Real lives, real results
For patients, the change has been life-altering and this can be viewed below.
The cost-effective nature of the initiative has also impressed stakeholders. The entire pilot spanning 2½ years, including app development, was delivered for €900,000 well below the initial €1.17 million budget.
By helping patients manage their condition in the community, the programme not only improves lives but is aligned with the Sláintecare principles of right place, right time, right person. This pathway has improved access to care for patients and has reduced the number of referrals that are being sent to the acute hospitals’ Outpatient departments.
Clinical leaders champion change
The clinicians leading the project emphasise that the development of integrated care pathways is one of the strategies that needs to be developed and implemented nationally in order to meet the increasing demand associated with an ageing population and changing demographic.
Mr Finbarr Condon and Mr Tom McCarthy, Joint Clinical Leads for the National Clinical Programme for Trauma and Orthopaedic Surgery, stress the importance for the HSE to continue to mainstream projects such as this which have demonstrated significant value, firstly for the patients, and secondly for the optimal utilisation of all available resources in both primary and secondary care settings.
National implementation will ensure that all patients have equal access to the most appropriate care at the right time.
A model for broader reform
More than just a pilot, the Hip and Knee OA Pathway is being held up as a blueprint for tackling other musculoskeletal conditions that benefit from early intervention and lifestyle-based management.
“We’ve seen what’s possible when you start with the patient, not the procedure,” notes Mr Walsh “And it aligns perfectly with the Sláintecare vision: earlier access, smarter use of resources and better health outcomes.”
The programme’s emphasis on self-management and digital support also dovetails with broader trends in healthcare innovation, particularly in rural and remote areas where access to in-person services can be limited.
With strong clinical backing and overwhelmingly positive patient feedback, the next phase will likely focus on scaling the programme across the country, giving more people the tools they need to move with confidence again. 
