Musculoskeletal conditions are very common across Europe, affecting all ages, and the associated physical disability is an enormous burden on individuals and society.¹ They can be effectively prevented and controlled in many situations but this is not at present fully achieved, partly because people—both the public and health professionals—are unaware of what modern management has to offer. Timely access to appropriate management is essential for all those who have musculoskeletal problems if the burden is to be reduced,² but this is not the situation for all across Europe. The European Union of Medical Specialists (UEMS) Section of Rheumatology/European Board of Rheumatology have made recommendations in this issue of what services are required to meet these needs.

There are several reasons why the best outcomes are not achieved for people with musculoskeletal conditions. There is a lack of understanding of the impact that these conditions have, as they are mostly non-fatal and the greatest effects are at increasing ages. Although the impact of rheumatoid arthritis is better recognised, many consider conditions such as osteoarthritis and osteoporosis as natural parts of ageing, and back pain is so common that it is often considered normal in people performing heavy-lifting jobs. As a consequence, people with musculoskeletal pain often delay seeing a physician and do not always follow advice as they fear that the treatment is worse than their problem.³ When they do consult a primary care physician, the physician may not be expert or interested in the management of the musculoskeletal problem. Undergraduate medical education is inadequate in musculoskeletal conditions,^4,5 and many primary care physicians do not gain any further specific training in the management of these conditions. Many doctors will, therefore, have little or an outdated …