Musculoskeletal problems are common in primary care and it is estimated that they account for 25% of GP consultations. Many of the patients` learned behaviours apparent in chronic musculoskeletal pain have their genesis in the first few days and weeks of the problem signifying the importance of the early care provided for patients by primary care health professionals and especially GPs. There is considerable scope for augmenting existing GP musculoskeletal skills and knowledge especially for common conditions such as shoulder pain for which there is no clear national guidance on their management.

The aims of the project were:

• To systematically review studies (Cochrane Review) on the effectiveness of educational and professional interventions targeting GPs' management of musculoskeletal conditions, therefore identifying the features of successful interventions;
• To lead the development and evaluate the impact of a multifaceted professional intervention for GPs designed to improve the management of low back pain, osteoarthritis and shoulder pain in primary care. The components of the intervention include a combination of referral audit, peer review and facilitated reflection as well as educational opportunities and local pathway dissemination. Outcomes are GP engagement, an assessment of the impact on GP referral rate and quality and patient satisfaction;
• To develop and evaluate an on-line learning module on the management of shoulder pain by GPs. The evaluation of the module includes GP feedback and change in knowledge scores before and after the module.