The Digital Bridge: Integrations of Clinical Musculoskeletal Pathways and Workforce Economic Activity via the getUBetter Platform
- Lloyd Price
- 3 hours ago
- 16 min read
Executive Summary
The nexus between individual health and economic productivity has become a focal point of public policy in the United Kingdom, particularly in the wake of post-pandemic shifts in workforce participation. A significant driver of economic inactivity is the prevalence of long-term sickness, with musculoskeletal (MSK) conditions representing a dominant category of morbidity. The traditional bifurcation of health services, delivered by the National Health Service (NHS) and employment support, overseen by the Department for Work and Pensions (DWP) and private employers, has created systemic inefficiencies.
Patients suffering from conditions such as low back pain or sciatica often find themselves navigating two disconnected systems: a clinical pathway focused on symptomatic relief and an employment landscape demanding functional capacity. The resulting "silo effect" contributes to prolonged recovery times, increased medicalisation of social problems, and unnecessary exits from the labour market.
This report presents an analysis of getUBetter, a digital health platform designed to bridge this chasm. Operating as a Class 1 Medical Device, getUBetter provides evidence-based, self-management support across the entire clinical pathway for common MSK injuries and women's pelvic health conditions. However, its strategic significance extends beyond clinical therapeutics; by integrating specific "work support" modules and connecting directly with local employment services, the platform functions as a digital infrastructure for the "Work as a Health Outcome" agenda.
Our analysis draws upon a wide array of evaluations, policy documents, and clinical case studies to demonstrate how getUBetter aligns with national initiatives such as the WorkWell vanguard programme. The evidence suggests that the platform’s "whole pathway" approach, combining immediate digital triage, safety netting, and vocational guidance, delivers measurable economic benefits. These include a return on investment (ROI) of £4.20 for every £1 spent, an 11% reduction in sickness absence notes in pilot areas, and significant decreases in primary and secondary care utilisation.
Furthermore, the platform's robust governance framework, utilising Digital Technology Assessment Criteria (DTAC) certification and co-design principles, provides a scalable model for addressing health inequalities and digital exclusion.
As the NHS faces unprecedented demand and the government seeks to reverse trends in economic inactivity, getUBetter illustrates the potential of digital therapeutics to serve as a "force multiplier," enhancing clinical capacity while simultaneously supporting the vocational rehabilitation of the workforce.
1. The Macro-Strategic Context: The Crisis of MSK Health and Economic Inactivity
1.1 The Burden of Musculoskeletal Conditions on the UK Economy
To understand the strategic necessity of platforms like getUBetter, one must first appreciate the scale of the MSK crisis. Musculoskeletal conditions, encompassing back pain, osteoarthritis, and soft tissue injuries—are the leading cause of years lived with disability in the UK. They account for approximately 30% of all General Practitioner (GP) consultations and cost the NHS an estimated £5 Billion annually in direct treatment costs.However, the indirect costs to the wider economy, driven by lost productivity and sickness absence, are exponentially higher.
Data from the Office for National Statistics (ONS), referenced within the getUBetter impact framework, highlights that in June 2022 alone, 262,272 people reported having back and neck pain significant enough to force them to leave the workforce entirely. This statistic represents a profound failure of early intervention. For many of these individuals, the journey from acute pain to permanent economic inactivity is gradual. It often begins with a minor injury, followed by a wait for physiotherapy, leading to physical de-conditioning, loss of confidence, and eventual detachment from the labour market.
The economic implications are stark. The "Get Britain Working" White Paper and subsequent Green Papers have identified health-related economic inactivity as a critical barrier to national growth. The government’s ambition to raise the employment rate to 80% is fundamentally largely dependent on stemming the flow of workers onto long-term sickness benefits. In this context, MSK health is not merely a clinical issue; it is a macroeconomic variable.
1.2 The Systemic "Silo" Failure
The core structural deficiency addressing this crisis is the historical separation of clinical care and vocational support.
The Clinical Silo: When a patient presents to a GP with back pain, the clinical focus is on pain reduction and pathology exclusion. The GP has limited time (typically 10 minutes) and often lacks the specific occupational health training to advise on workplace adjustments. Consequently, the default administrative action is often the issuance of a "fit note" signing the patient off work entirely, rather than a nuanced plan for modified duties.
The Employment Silo: Employers and Jobcentres operate with limited visibility into the clinical reality of their employees or clients. Occupational Health (OH) services are often restricted to large corporate entities, leaving Small and Medium Enterprises (SMEs) and the self-employed, who make up a vast proportion of the workforce, without professional guidance.
This disconnection creates a vacuum where the patient receives neither adequate medical treatment (due to waiting lists) nor adequate vocational support. getUBetter was conceptualised specifically to dismantle these silos. By embedding work-specific guidance within the clinical recovery app, it ensures that "return to work" is treated as a clinical outcome, intrinsic to the recovery process rather than an afterthought.
1.3 The Psychological Impact of Waiting
The "waiting list" is a passive state in traditional healthcare, but biologically and psychologically, it is an active period of deterioration. Patients waiting for MSK appointments often engage in "fear-avoidance" behaviours—avoiding movement or work for fear of causing damage. This inactivity leads to muscle atrophy (de-conditioning) and reinforces a "sick role" identity.
getUBetter intervenes in this specific temporal gap. By providing immediate access to safety-netted advice and exercises, it transforms the "wait" into a period of "pre-habilitation." The platform’s data indicates that 50% of patients on a physiotherapy waiting list who used the app felt sufficiently recovered to remove themselves from the list. This finding suggests that for a significant cohort, the provision of confidence and knowledge is as effective as clinical contact, preventing the psychological entrenchment of disability.
2. Platform Architecture and Clinical Philosophy
2.1 The "Whole Pathway" Approach
A distinguishing feature of getUBetter is its rejection of the "point solution" model often seen in digital health, where an app might address only "back pain exercises" or "mindfulness for pain." Instead, getUBetter employs a "whole pathway" architecture. This means the digital infrastructure mirrors the patient's entire journey through the health system, from the initial onset of symptoms (acute phase) through to recovery, return to work, and long-term prevention.
The platform covers a comprehensive suite of MSK pathways:
Spinal: Non-specific low back pain, back and leg pain (sciatica), neck pain.
Peripheral Joints: Shoulder, elbow, wrist, hand, hip, knee, ankle, and foot pain.
Soft Tissue: Sprains, strains, and tendinopathies (Achilles, gluteal, tennis elbow, etc.).
Complex/Chronic: Osteoarthritis management and "Living with Pain" modules.
Women’s Pelvic Health: Pre- and post-natal care, incontinence, and menopause support.
Crucially, the "whole pathway" concept extends to the setting of care. The app is designed to be accessible wherever the patient interacts with the system. A patient might be signposted to the app by a community pharmacist, self-refer via a GP website, or be directed by NHS 111. Regardless of the entry point, the patient enters a standardized, evidence-based care funnel that is consistent with local clinical protocols.
2.2 Mechanism of Action: The COM-B Behaviour Change Model
The efficacy of getUBetter is rooted in behavioural science, specifically the COM-B model (Capability, Opportunity, Motivation - Behaviour). The platform operates on the premise that information alone is insufficient to drive recovery; patients require behavioural scaffolding to change how they manage their condition.
COM-B Component | Implementation in getUBetter | Strategic Implication |
Capability | Provides educational videos, symptom checkers, and clear explanations of conditions to increase health literacy and physical skills for exercises. | Patients understand why they hurt, reducing fear and increasing compliance with rehab. |
Opportunity | Offers 24/7 access on mobile devices, removing barriers related to appointment availability, travel, or waiting lists. Connects users to local physical assets (e.g., leisure centres). | Democratizes access to high-quality physio advice, regardless of geography or shift patterns. |
Motivation | Uses progress tracking, reassurance ("safety netting"), and personalized goals to build confidence (self-efficacy) and reduce anxiety about pain or work. | shifts the patient from a passive recipient of care to an active manager of their health. |
This behavioural framework is particularly relevant to the "return to work" objective. A patient who possesses the capability to manage a flare-up at work (e.g., knowing specific stretches) and the motivation derived from understanding that hurt does not equal harm, is significantly more likely to remain in employment.
2.3 Safety Netting and Risk Stratification
As a Class 1 Medical Device, getUBetter incorporates a robust safety architecture designed to manage clinical risk remotely. This is achieved through a multi-layered system of "safety netting".
Initial Triage: Upon registration, patients must answer a series of "red flag" screening questions. These screen for signs of serious pathology such as Cauda Equina Syndrome (bladder/bowel dysfunction), severe trauma (fractures), or infection. If a red flag is detected, the app prevents registration and directs the patient to the appropriate urgent care service (A&E or GP), thereby preventing inappropriate self-management of dangerous conditions.
Longitudinal Symptom Checking: The app does not assume a linear recovery. It includes regular symptom checks. If a patient reports worsening symptoms or new neurological signs (e.g., numbness), the app triggers a safety alert, advising the user to seek professional help. This automates the clinical safety netting that a doctor would verbally provide, ensuring it is reinforced throughout the recovery journey.
Clinical Governance: All content is signed off by local clinical teams within the Integrated Care System (ICS). This ensures that the advice aligns with local protocols and formularies, and that the "signposting" directs patients to valid local services.
3. Connecting Health and Work: The Digital Intervention
3.1 The "I'm Struggling to Work" Module
Recognising that employment concerns are a primary driver of patient anxiety and system cost, getUBetter has developed specific "targeted support modules" that sit within the condition pathways. These include "I'm struggling to work," "I'm on a waiting list," "I have pain," and "I have arthritis".
The "I'm struggling to work" module represents a significant innovation in digital MSK care. It moves beyond generic medical advice to provide specific vocational guidance:
Sickness Absence Administration: The module provides clear information on self-certification, the role of the "fit note" (formerly sick note), and statutory sick pay rights. This demystifies the administrative burden for patients who may be navigating the benefits system for the first time.
Return to Work Planning: It offers practical frameworks for phased returns, discussing "reasonable adjustments" with employers, and managing fatigue. This empowers the employee to approach their line manager with a constructive plan rather than a binary "sick/not sick" status.
Vocational Confidence: The content addresses the psychological barriers to returning to work, such as the fear of re-injury. It includes techniques for managing pain in the workplace, tailored to different job archetypes (e.g., sedentary desk work vs. active manual labour).
Local Signposting: Crucially, the module connects the digital user to physical employment support. It can signpost directly to local Access to Work schemes, occupational health providers, or initiatives like the WorkWell coaching service.
This module effectively decentralizes occupational health advice. By making high-quality vocational guidance available to the general population, it supports the millions of workers in the "gig economy," small businesses, or self-employment who lack access to corporate occupational health departments.
3.2 The Birmingham and Solihull Employer Portal
The practical application of this "Health and Work" strategy is exemplified by the Birmingham and Solihull (BSol) ICS deployment. Here, getUBetter has been integrated not just into GP practices, but directly into the regional employment infrastructure. The ICS established a dedicated registration portal for local employers.
This initiative allows any employer in the region, from a small café to a large manufacturing plant—to register and provide getUBetter to their staff as a free wellbeing benefit.
Process: Employers complete a simple form with their company details. They receive a unique access code or QR code to distribute to staff.
Accessibility: Employees register using the app, entering their work postcode if they live outside the area but work within it. This ensures the transient workforce is covered.
Confidentiality: A critical design feature is the strict firewall between the user's health data and the employer. The app is completely independent; the employer knows they have provided the tool, but receives no data on who is using it or for what condition. This overcomes the "trust barrier" where employees fear disclosing health issues to management.
Integration with "Easychange": The BSol deployment also integrates with Easychange, a broader wellbeing app covering stress, smoking cessation, and alcohol reduction. This creates a comprehensive "digital occupational health" suite for the region's employers, funded entirely by the ICS.
3.3 The Role of Occupational Health Providers
getUBetter also partners with private Occupational Health (OH) providers. In this context, the platform serves as an adjunct to professional OH services. An OH advisor might assess an employee and then "prescribe" the app to provide daily recovery support between appointments. This hybrid model enhances the capacity of OH services, allowing high-cost human professionals to focus on complex case management while the digital platform handles routine education and rehab adherence.
4. National Policy Integration: WorkWell and NHS 111
4.1 The WorkWell Vanguard Programme
The WorkWell programme is a flagship UK government initiative, jointly funded by the DWP and DHSC with a £64 Million investment. It aims to integrate health and employment support at a local level, piloting in 15 "Vanguard" areas. getUBetter has been positioned as a key digital enabler within these pilots.
In Birmingham and Solihull, designated as a WorkWell Vanguard, getUBetter functions as a digital triage point for the service. The workflow is designed to identify "at-risk" workers early:
Identification: A worker struggling with back pain is identified via their GP, employer, or self-referral.
Digital Intervention: They access getUBetter for immediate clinical support.
Risk Stratification: If the user engages with the "I'm struggling to work" module or reports high vocational distress, the app can signpost them to the WorkWell service.
Human Intervention: A Work and Health Coach then picks up the case. The coach focuses on the psychosocial and structural barriers to employment (e.g., negotiating hours, CV support), knowing that the clinical management is being handled by the app.
This symbiosis allows for "low-level health interventions" (like the app) to run in parallel with intensive employment coaching, preventing the duplication of effort and ensuring the patient receives holistic support.
4.2 Sussex WorkWell Discovery
In Sussex, another WorkWell area, the discovery phase highlighted the need for services that act as "connectors" across fragmented systems. Stakeholders emphasized that a digital front door like getUBetter could help "clear pathways" for specific cohorts, avoiding the confusion of multiple entry points. The report underscored the necessity of embedding such tools within trusted community settings (e.g., VCSEs) and aligning them with existing MSK pathways to ensure sustainability.
4.3 Integration with NHS 111 in South East London
A critical advancement in systemic integration is the embedding of getUBetter into the NHS 111 pathway. NHS 111 is often the first point of contact for acute MSK pain. In South East London (Lambeth, Southwark, Bexley), the system has been configured so that patients contacting 111 with low back pain can be directed to getUBetter.
Current State: Call handlers or clinicians can refer suitable patients to the app via SMS after telephone triage.
Future State (NLP): The project is advancing towards using AI-powered Natural Language Processing (NLP). This technology will analyse the caller's spoken symptoms to identify "low back pain" cases automatically, offering the app earlier in the journey. This "left shift" prevents patients from needing to wait for a clinician callback or attend an Urgent Treatment Centre (UTC), reducing pressure on the 111 service and empowering patients with immediate relief.
4.4 DWP and "Better Working Futures"
In South London, getUBetter has formed a partnership with Better Working Futures, an employment support programme. Jobcentre Plus advisors and employment coaches can recommend the app to participants whose health is a barrier to finding work. This cross-sector referral acknowledges that a job seeker with untreated knee pain is unlikely to be successful in securing employment. By treating the health condition, the employment service improves its own outcomes.
5. Clinical Validity, Governance and Safety
5.1 Regulatory Status and Certification
For a digital health technology to be adopted at scale within the NHS, it must meet rigorous regulatory standards. getUBetter has achieved a high level of compliance, which is essential for building trust among the clinicians who prescribe it.
Medical Device Class 1: The platform is registered with the Medicines and Healthcare products Regulatory Agency (MHRA) as a Class 1 Medical Device. This certifies that it meets essential safety and performance requirements.
DTAC Certified: It has passed the Digital Technology Assessment Criteria (DTAC), the NHS's baseline standard for digital health. This assessment covers clinical safety, data protection, technical security, and usability/accessibility.
DCB0129 Compliance: The company adheres to the DCB0129 clinical risk management standard, employing Clinical Safety Officers to oversee the design and deployment of the algorithms.
ORCHA Rating: getUBetter is the highest-scoring MSK app on the ORCHA app library (scoring 91%). ORCHA is the leading independent review body for health apps, providing assurance on data privacy, clinical assurance, and user experience.
5.2 NICE Recommendations
The National Institute for Health and Care Excellence (NICE) has specifically recommended getUBetter in its Early Value Assessment (EVA) guidance for the management of non-specific low back pain. NICE highlighted the platform's potential to reduce GP appointments and its suitability for safe self-management, provided screening questionnaires are used (which are built into the app). This endorsement is a critical driver of adoption, signalling to ICS commissioners that the technology is evidence-based.
5.3 Data Privacy and Security
Given the sensitivity of health data, particularly in the context of employment, getUBetter employs enterprise-grade security.
Encryption: Data is encrypted in transit and at rest.
Hosting: The service is hosted on AWS Cloud, benefiting from 24/7 monitoring by a Network Operations Centre (NOC).
Data Sanitisation: Explicit overwriting of storage is used before reallocation to ensure deleted data cannot be accessed.
Penetration Testing: Annual "IT Health Checks" are performed by CREST-approved providers to identify vulnerabilities.
No Commercial Data Sharing: The platform explicitly states that patient data is never sold to third parties. This is crucial for maintaining user trust.
6. Women's Pelvic Health: A Workforce Catalyst
6.1 The Hidden Barrier to Employment
getUBetter places a strong strategic emphasis on Women’s Pelvic Health, identifying it as a neglected area that significantly impacts female workforce participation. Conditions such as stress urinary incontinence, prolapse, and menopause symptoms affect a vast proportion of the female workforce. Over 80% of women report that these symptoms affect their ability to work, yet stigma often prevents them from seeking help or discussing adjustments with employers.
6.2 Targeted Modules and SBRI Funding
The platform offers dedicated pathways designed to support women through key life stages that interact with their careers:
Perinatal Support: Pathways for pregnancy and post-natal recovery help women manage pelvic floor issues, diastasis recti, and return to physical activity. This support is vital for facilitating a smooth return to work after maternity leave.
Menopause: A specific module addresses the MSK and pelvic symptoms associated with menopause. As the workforce ages, retaining experienced women going through menopause is a key economic priority. The app provides symptom management strategies that can help women remain productive and reduce exit from the labour market.
Wales SBRI Project: The strategic importance of this work was validated by a funding award from SBRI Healthcare to scale the pelvic health platform across Cwm Taf Morgannwg University Health Board in NHS Wales. This project aims to reduce inequalities in a region with high deprivation, using the digital platform to provide equitable access to pelvic health support.
6.3 Digital Inclusion in Pelvic Health
The pelvic health modules are designed with inclusivity at the core. They include features like "touch to speak" and video subtitles in 10 languages, ensuring that women from minority ethnic backgrounds or those with lower literacy can access the support. This is critical in areas like East Birmingham or the Welsh Valleys, where health inequalities often correlate with language barriers.
7. Real-World Evidence and Economic Impact
7.1 Return on Investment (ROI)
The economic argument for getUBetter is robust, supported by evaluations across multiple ICSs involving thousands of patients. The platform consistently demonstrates a Return on Investment (ROI) of approximately 1:4.2, meaning that for every £1 an ICS spends on the license, it recoups £4.20 in system savings.
7.2 Utilisation Metrics and "Left Shift"
The platform drives a significant "left shift" of activity, moving care from high-cost clinical settings to low-cost self-management.
GP Appointments: Evaluations show a 13% reduction in first-time GP appointments and a 15% reduction in repeat appointments for MSK conditions. This releases valuable GP time for complex patients.
Physiotherapy: Referrals to physiotherapy are reduced by 20%. Furthermore, patients who use the app while on a waiting list require 40% fewer appointments when they are eventually seen, suggesting the app acts as effective "pre-habilitation".
Urgent Care: A striking 66% reduction in Urgent Care/Emergency Department attendances for MSK issues has been reported. This is a critical metric for reducing pressure on the overstretched emergency pathway.
Prescriptions: A 50% reduction in MSK medication prescriptions indicates that users are effectively managing pain using the non-pharmacological techniques (exercise, heat/ice, behavioural change) provided by the app.
7.3 Return to Work and Sickness Absence
The impact on workforce metrics is equally compelling.
Sick Note Reduction: In the Frimley ICS area, the deployment of getUBetter was associated with an 11% reduction in sick notes issued for MSK conditions. This directly translates to improved workforce productivity and reduced costs for employers and the state.
Waiting List Validation: In a study involving 14,500 patients on a community MSK waiting list, 69.6% of getUBetter users removed themselves from the list—a rate nearly 30% higher than non-users. Additionally, 21% of users explicitly reported that the app helped them get back to work, citing improved confidence as a key factor.
Patient Feedback: Qualitative data reinforces the quantitative findings. Patients report feeling "reassured" and "confident," with one user noting, "It helped me get better faster, and with more confidence... extremely helpful to see the exercises being done".
7.4 Table of Key Impact Metrics
Metric | Reduction / Improvement | Strategic Consequence | Source |
ROI | 1 : 4.2 | High value for money; sustainable for ICS budgets. | NHS |
GP Appts (First) | - 13% | Releases primary care capacity. | NHS |
GP Appts (Repeat) | - 15% | Reduces "frequent flyer" demand. | NHS |
Physio Referrals | - 20% | Shortens waiting lists for complex cases. | NHS |
Urgent Care Visits | - 66% | Relieves A&E pressure. | NHS |
Prescriptions | - 50% | Reduces opioid dependency risk; cost saving. | NHS |
Sick Notes | - 11% | Improves workforce retention (Frimley). | NHS |
Waiting List Removal | 69.6% | Validates "wait well" / pre-hab strategy. | NHS |
8. Deployment Strategy and Future Outlook
8.1 The Rapid Clinical Transformation Model
getUBetter has developed a methodology for deployment that allows it to launch across an entire ICS (serving millions of people) in as little as four weeks.This "Rapid Clinical Transformation Model" involves:
Local Configuration: Adapting the app to local pathways (e.g., ensuring the "self-referral" button links to the correct local physio provider).
Stakeholder Engagement: Workshops with GPs, physios, and patient groups to ensure buy-in.
Technical Integration: Seamless integration with GP systems (like EMIS and SystmOne) to allow "one-click" prescribing via SMS.
Campaign Assets: Providing physical and digital marketing materials (posters, social media assets) to drive patient uptake.
8.2 Environmental Impact (The Green Plan)
The platform aligns with the NHS "Green Plan" (Net Zero). By enabling remote management, it significantly reduces the carbon footprint associated with patient travel to appointments. The reduction in unnecessary physical appointments contributes to a greener, more sustainable health service.
8.3 Future Roadmap: AI and The NHS App
Looking ahead, getUBetter is positioning itself for deeper integration into the national digital infrastructure.
NHS App Integration: The platform is working towards full interoperability with the NHS App. Once achieved, this will allow the 30+ million NHS App users to access getUBetter content directly, potentially making it the default standard of care for MSK across England.
Predictive Analytics: The collection of anonymized population health data (e.g., heatmaps of back pain prevalence) offers the potential for predictive analytics. This could help ICSs and local authorities proactively target public health interventions (e.g., subsidised gym memberships) in areas with emerging MSK hotspots.
Conclusion
The convergence of high MSK disease burden, growing economic inactivity, and strained healthcare capacity creates a "perfect storm" that traditional models of care cannot weather. getUBetter has emerged not merely as a therapeutic app, but as a systemic solution to this multifaceted crisis.
By successfully bridging the gap between the clinical silo (NHS) and the vocational silo (DWP/Employers), getUBetter operationalizes the concept that work is a health outcome. Its integration into flagship government programmes like WorkWell, its deep embedding into NHS 111, and its partnerships with employment services demonstrate a maturity that transcends the typical "digital health startup" narrative.
The evidence is clear: when patients are empowered with the capability to understand their condition, the opportunity to access immediate care, and the motivation derived from safety-netted support, they recover faster and return to work sooner. For an Integrated Care System, getUBetter offers a rare "triple win": improved patient outcomes, reduced system costs, and a healthier, more productive regional workforce. As the UK seeks to "Get Britain Working," the scalable, evidence-based digital infrastructure provided by getUBetter offers a blueprint for the future of integrated health and employment support.
