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Service Delivery evaluation of a triage and treat model involving the delivery of chiropractic care in partnership with a primary care group in Essex

Primary Care Population Sciences and Medical Education

Location:  Aldermoor Health Centre
Closing Date:  Friday 31 January 2020
Reference:  1224420LG

Main Supervisor: David Newell

Other members of the supervisory team: Michael Moore, Mark Gurden (external), Jane Vennik, Neil Osborne (external), Jonathan Field

Duration of the award: Six years part-time

Project description: 

General background: The global burden of disability is high for MSK conditions   with low back pain being notable in the UK as the primary cause of years of life lost to disability with neck pain ranking 4th

The workload burden of MSK in UK primary care is likely considerable if difficult to precisely quantify. Various figures put new consultation rates at around 1 in 5 of GP visits. Consultations for low back pain constitute a significant proportion of this figure with Arthritis UK in 2011 estimating around 7% of all GP visits for this condition. Societal costs of low back pain are also high as is the burden of pain and disability for patients, particularly those with chronic conditions. 

Recent American Medical Association guidelines and a series of papers in the Lancet recommend that for non-specific acute or chronic low back pain conservative non pharmacological approaches should be used as first line of care marking a considerable shift away from surgical procedures and pharmaceutical approaches. This because recent studies show little benefit over and above placebo for well-known analgesics such as paracetamol and NSAIDs but with concomitant harm associated. This recommendation is reflected in other international guidelines including that of the National Institute of Clinical Excellence.   

Included in these recommendations as second line interventions are a range of manual therapeutic approaches to care including spinal manipulative therapy. UK based professions delivering care that include such modalities constitute osteopaths, chiropractors and some physiotherapists. At least for Osteopaths and chiropractors the clinical services they deliver exist predominantly in the independent sector with ow rate of utilisation due to barriers in accessing such care from within the NHS. 

Despite the small size of the chiropractic workforce, given the size of the burden and the possibility for local solutions to emerge in the delivery of guideline supported care, the exploration of models that facilitate the delivery of chiropractic care in conjunction or aligned with the primary care sector appears worthwhile. While national solutions for the treatment of back pain and sciatica have already emerged with the National Back Pain Pathway Triage and Treat model, the  involvement of the chiropractic profession are minimal or absent. 

This PhD then aims to explore the journey through a unique pathway jointly provided by a GP primary care group and a group of chiropractic clinics in Essex. The goal would be to collect pertinent data that document both the lived experience of patients going through such a pathway using qualitative methodology as well as collecting relevant clinical outcomes through using PROMs and NHS health care seeking and cost data using Secondary Uses Service (SUS) data. Included as major outcomes would be reduction in GP load and ongoing conversion rates with orthopaedic consultations in secondary care.  Please note that we will also consider applications from those interested in full-time Study.

Please contact:  David Newell

Person Specification:  See below

The successful candidate is likely to have the following qualifications:

  • A 1st or 2:1 degree in a relevant discipline and/or second degree with a related Masters

Funding information:  £9,000.00 plus tuition fees for six years part-time.

Administrative contact and how to apply:

Please complete the University's online application form, which you can find at

You should enter David Newell as your proposed supervisor. To support your application provide an academic CV (including contact details of two referees), official academic transcripts and a personal statement (outlining your suitability for the studentship, what you hope to achieve from the PhD and your research experience to date).

Informal enquiries relating to the project or candidate suitability should be directed to David Newell (

Closing date: Friday, 31st January 2020

The closing date for this job opportunity has now passed, and applications are no longer being accepted for this position

Further details:
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