A minority of my community caseload relates primarily to muscle and joint pain. Most patients with these problems can usually reach a clinic and do not need home visit. The priority patient for community services are normally those who are housebound. So when do patients with musculoskeletal issues call a community clinician? From my experience, they have been in the following situations:
They have a co-morbid mobility issue
They are a carer themselves and cannot leave a loved one alone
They live with cognitive or mental health issues and value more time from their appointments
They have ME/CFS and struggle to mobilise any significant distance out of the house
Their partner has received input in the past, and the service is already known to them
Individual community services will each have their own criteria for provision, though the above points are my criteria for provision to patients with musculoskeletal patients.
Community appointments can offer longer appointments to meet the needs of individuals with additional clinical issues. Experience allows the ability to adapt to the specific problems that patients may have and which would otherwise have made it difficult to be managed within a standard clinic appointment. Commonly this involves providing manual therapies for those who cannot get on/off a plinth, or find it difficult staying in one position for more prolonged periods.
Additionally, most of the equipment found in clinics can be brought to you including acupuncture and standard electrotherapies. Indeed, in 2001 the decision to re-invest back into the service was made, with vehicle upgrade to a Euro 6 rated van, allowing transport and provision of an even wider range of equipment for patients.
Finally, I will always try signpost to another provider who is better placed to see you if needed and/or if at capacity myself.