Co-producing Solutions to Hip and Knee Problems

Naomi Stanton, GP

Cwm Taf University Health Board


Collectively, musculoskeletal conditions are the greatest cause of disability in the UK accounting for a third of years lived with disability. Between 1990 and 2010 the disability due to OA has increased by 16%.

Cwm Taf University Health Board has among the highest rate of referrals to orthopaedics and the highest rate of conversions to surgery in Wales.

GP referrals to orthopaedics in Cwm Taf are above the Welsh average, with an average of around 800 referrals per month.

The World Health Organisation (WHO) defines Health Literacy as: “… personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health.”

Health Literacy is a key determinant of health. There is a strong correlation between low literacy and low numeracy skills and poor health literacy. Poor Health Literacy in turn is associated with poorer health and poorer health outcomes. Poor health literacy is associated with increased hospital admissions and readmissions, less participation in preventive activities, higher prevalence of health risk factors, poorer self-management of chronic conditions and poorer disease outcomes, lower functional status and increased mortality. Improving Health Literacy is a key priority for WHO and Royal College of General Practitioners and the Welsh Government because of the link between poor Health Literacy and poor health outcomes, and is also an enabler to reduce health inequalities.


The overall project aim is to tailor interventions based on Health Literacy baseline levels to improve this asset in order to allow patients to choose alternative strategies for management and to ensure more appropriate selection of patients for surgery through working with citizens and local communities to co-design solutions to their health needs.


Phases 1 and 2 are currently underway.

Phase 1:

Phase 2:

Three workshops:

Workshop 1 – Citizens: To co-design interventions to improve self-management of their condition and develop tools to help informed, shared decisions about management options;

Workshop 2 – Healthcare Professionals: Healthcare professionals such as orthopaedic surgeon and physiotherapists to discuss their understanding of the challenges and solutions;

Workshop 3 – Citizens & Healthcare Professionals: Workshop to allow citizens and healthcare professionals to co-design interventions. Evaluate the co-production sessions.

Phase 3:

Implement the interventions co-designed on a new cohort of 100 patients referred in by their GP.

Phase 4:

Evaluate interventions regarding impact on patient decisions about management options including a cost-effectiveness analysis. Evaluate Health Literacy following co-design events and implementation of interventions.


Part of cohort Bevan Exemplar Projects 2016-17