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Musculoskeletal - MSK Service, part of Circle Integrated Care, is a single point of access for musculoskeletal conditions

Bedfordshire

The Bedfordshire MSK Service, part of Circle Integrated Care, is a single point of access for musculoskeletal conditions.

All patients over 18 years old with an MSK condition registered with a Bedfordshire GP should be sent to the Circle Hub for triage (preferably via E-Referral).

Referrals will be triaged by specialist MSK Advanced Physiotherapy Practitioner (APP) to the most appropriate treatment pathway and patients will be offered a choice of provider, where available. Patients will be monitored and supported across their pathway.

Clinical triage will be performed within 24 hours. If referrals have insufficient information, Circle staff will contact the practice to request additional information.

How do I refer patients to the service?

The preferred method of referral is to E-refer. This is a more secure referral method and ensures we have quick and easy access to all patient information. However, other methods of referral are through:

Emailmsk.bedfordshire@nhs.net

Post:

Circle Integrated Care
Regent House
Wolseley Road
Kempston
Bedford
MK42 7NY

The following specialities are covered by the MSK service:

  • Orthopaedics
  • Pain management
  • Physiotherapy
  • Rheumatology
  • Podiatry (MSK)
  • Podiatric surgery

Patients will be triaged to either:

  • Physioline. Patients will have the opportunity to speak with a physiotherapist who can assess their condition over the phone and can suggest exercises and other management techniques with reference to leaflets and online video demonstrations. If, after assessment, the problem is more complex, face-to-face physiotherapy will be arranged.
  • Physiotherapy. Patients will be referred for face-to-face physiotherapy.
  • Community MSK. Patients will be assigned to either an APP or a GP with a Special Interest in MSK medicine, for a detailed assessment and work-up.
  • Secondary Care. Our Patient Choice team will offer patients a choice of provider, and our Shared Decision Making team will contact patients with certain conditions such as hip and knee osteoarthritis to discuss treatment options.

What happens when patients leave the service:

When a patient has completed their course of treatment, the Bedford MSK Service will discharge the patient back their GP with a clear discharge plan.
Should a patient’s condition require further treatment, and/or onward referral to another allied service, this will be arranged through the Circle MSK hub, and should not require further input from the patient’s GP.

A patient did not attend (DNA) a hospital MSK appointment:

If a patient has DNA-ed a hospital attendance, Circle will accept a direct contact at the Integrated Provider Hub from the patient so they can establish if their condition has changed and if the same pathway is still appropriate or if a new or different service is available, and to book them an appointment. The patient will also be able to access the service via the self-referral route.

The Circle Bedford MSK team will advise the patient on their choice of provider:

If a patient has a particular preference for a hospital, the choice team will discuss this with them and arrange onward referral. Once it has been agreed with the patient they will be referred to secondary care a conversation with a choice adviser will be arranged.

Do I need to obtain permission from individual Funding Request (IFR) panel before I refer to the MSK service?

No, you do not need to obtain permission from the IFR for Procedures of Low Clinical Value (PLCV). Circle Integrated Care holds the budget for all MSK conditions that are not within the exclusion criteria. We will manage the patient according to the clinical need and evidence-based guidelines. These include the Bedfordshire Surgical Thresholds and the Evidence-Based Interventions document published by NHSE in November 2018.

bedfordshire-msk-sugical-thresholds-jan-2017

https://www.england.nhs.uk/wp-content/uploads/2018/11/ebi-consultation-response-document-v2.pdf

If you have any queries regarding a referral please email circle.mskgpqueries@nhs.net for advice.

Where can I find guidelines on Procedures of Low Clinical Value?

A link to evidence base for Procedures of Low Clinical Value can be found at the link below

https://www.england.nhs.uk/wp-content/uploads/2018/11/ebi-consultation-response-document-v2.pdf

Exclusion criteria:

Age

Patients under the age of 18 years old at the time of referral. The MSK service is an adult service only

Red flags 

  • Fracture; Please refer to the local fracture clinic
  • suspected Cauda Equina; refer to local A&E is suspicion
  • Undiagnosed lumps and bumps
  • Suspected cancer; Please use 2ww pathway

Non-MSK conditions

  • Neurological disorders
  • Falls
  • ENT disorders e.g. vertigo, TMJ
  • Gynaecological referrals e.g. women’s health, Incontinence
  • Non-MSK podiatry e.g. corns, toenails, orthotics, callouses (MSK podiatry is included)
  • Chronic Fatigue Syndrome
  • Domiciliary physiotherapy

Clinical effectiveness

  • Acupuncture only referrals

If a potential cancer is found by Circle clinicians during the course of investigation, what is the process for referral under 2 week wait (2WW)?

Fortunately, it is rare for a potential malignancy to be found. If a positive result is received it has been agreed with the Bedfordshire CCG that the referral should be immediately referred back to the GP for onward referral to the hospital of their choice under the 2WW pathway. The reason this was agreed was to ensure the best patient pathway. The MSK service will endeavour to contact the patient first to inform them of the abnormal result but will also contact the GP without delay by phone to ensure a smooth transfer of information and responsibility.

Will the service support GPs?

Yes. The service is designed to support GPs and create integrated working. Initiatives include:

    • MSK Practitioners (First Contact Practitioners). Experienced physiotherapists will be offered to provide front-line clinics, free of charge, in GP surgeries. They will work side-by-side with GPs by assessing and treating, or triaging to further MSK services, at the first point of contact.
    • Continuous Professional Learning. Circle will provide education and training opportunities on MSK conditions, based on specific conditions, diagnostic methods and examination techniques. Further information can be seen below.
    • Clinical Steering Group. GPs, Consultants, Physiotherapists and other MSK professionals will have the opportunity to meet and discuss pathways and ways to improve the service.
If you have any questions, please contact our team on 01234 639000 or by email at msk.bedfordshire@nhs.net for general queries or circle.mskgpqueries@nhs.net for clinical queries 
Greenwich

The Greenwich MSK Service, part of Circle Integrated Care, is a single point of access for musculoskeletal conditions.

All patients over 18 years old with an MSK condition, who are registered with a Greenwich GP should be referred to the Circle Hub for triage (via e-Referrals).

Referrals will be triaged by specialist MSK Advanced Physiotherapy Practitioner (APP) to the most appropriate treatment modality and patients will be offered a choice of provider, where available. Patients will be monitored and supported across their pathway.

Clinical triage will be performed within 24 hours. If referrals have insufficient information, Circle staff will contact the practice to request further information.

How do I refer patients to the service?

Please complete the Circle MSK GP referral template and attach any appropriate imaging reports and/or relevant clinic letters.

Please send all referrals via eRS.

The Circle MSK Directories of Service is available and is visible only to Greenwich GPs. The following services can be found on NHS e-Referrals and will appear as shown below:

  • Rheumatology Triage – MSK – Circle Greenwich – NV03A
  • Podiatry Triage – MSK – Circle Greenwich – NV03A
  • Physiotherapy Triage – MSK – Circle Greenwich – NV03A
  • Pain Management Triage – MSK – Circle Greenwich – NV03A
  • Orthopaedic Triage – MSK – Circle Greenwich – NV03A
  • Musculoskeletal Triage – MSK – Circle Greenwich – NV03A

Please select one of these options but be aware that you will be booking your patient into a “dummy” slot, therefore please do not print off the e-RS booking letter.

Patients will be triaged to either:

  • Physioline. Patients will have the opportunity to speak with a physiotherapist who can assess their condition over the phone and can suggest exercises and other management techniques with reference to leaflets and online video demonstrations. If, after assessment, the problem is more complex, face-to-face physiotherapy will be arranged.
  • Physiotherapy. Patients will be referred for face-to-face physiotherapy.
  • Community MSK. Patients will be assigned to either an APP or a GP with a Special Interest in MSK medicine, for a detailed assessment and work-up.
  • Secondary Care. Our Patient Choice team will offer patients a choice of provider, and our Shared Decision Making team will contact patients with certain conditions such as hip and knee osteoarthritis to discuss treatment options.

What conditions are treated?

Circle triages all patients over 18 years old with an MSK condition. We offer a variety of treatments and many of our patients are referred onto local MSK services. Areas covered under the MSK service:

  • Orthopaedics
  • Pain management
  • Physiotherapy
  • Rheumatology
  • Podiatry (MSK)
  • Podiatric surgery

What happens when patients leave the service:

When a patient has completed their course of treatment, the Greenwich MSK Service will discharge the patient back their GP with a clear discharge plan. The content of the discharge will be structured to allow GPs to identify easily the key steps in a patient’s treatment regime, as well as to understand the interventions completed while under Circle MSK’s care.

Should a patient’s condition require further treatment, and onward referral to another allied service, this will be arranged through the Circle MSK hub, and should not require further input from the patient’s GP.

Rheumatoid arthritis patients:

All referrals should be made to Circle MSK and patients fitting the criteria for the Early Arthritis Clinic will be sent on urgently where required. We do not expect this will result in any additional delays as Circle MSK has a team of staff ready to triage referrals within 24 hours, who will notify the patient choice team to refer on urgently.

A patient did not attend (DNA) a hospital MSK appointment:

If a patient has been discharged from a provider due to non-attendance, Circle will require a new referral for this condition. This is to ascertain if there have been any changes in the condition and to determine if the same pathway is still appropriate.

If a patient wants to go to a specific hospital for a certain condition, how do they exercise choice?

All referrals should be made to Circle MSK and if a patient has expressed interest in a particular hospital at the point of referral, this can be included in the GP referral template.
The patient choice team will call the patient to discuss available options, bearing in mind that not all providers can offer the same range of services. The patient choice team will then arrange onward referral.
Local Consultants hold clinics at our hub in Eltham Community Hospital, which may be a more convenient option for some of our patients.
If we are unable to reach patients on the phone and there is a preference indicated on the GP template, we will refer on to avoid delay to the patient’s pathway.

If a potential cancer is found by Circle clinician during the course of investigation, what is the process for referral under 2 week wait (2WW)

Fortunately, it is rare for a potential malignancy to be found. In the event that malignancy, or potential malignancy, is identified on a scan, or if one of our clinicians has a strong suspicion from their history taking and examination, a Circle doctor will complete the appropriate 2WW referral form, and speak to the patient to advise them of the finding and referral – this will most often, necessarily, be over the phone.  We will also speak to the duty doctor at the patient’s GP practice to advise them of this.

In the event that further examination is indicated (e.g. a breast examination) we would usually request that the patient’s GP would arrange this. If we are unable to reach the patient after several attempts, we will usually send the referral anyway to ensure the 2WW pathway begins without undue delay, and inform the patient’s GP.

Will the service support GPs?

Yes. The service is designed to support GPs and create integrated working. Initiatives include:

  • A dedicated GP query email. GPs have access to a dedicated email address staffed by a team of senior clinicians who can support and advise on clinical queries. circle.greenwichgpqueries@nhs.net 
  • Continuous Professional Learning. Circle provides quarterly education and training opportunities on MSK conditions, diagnostic methods and examination techniques.
  • Clinical Steering Group. GPs, Consultants, Physiotherapists and other MSK professionals will have the opportunity to meet and review cases and develop pathways to improve patient care.
  • MSK Practitioners. Experienced physiotherapists will be offered to provide front-line clinics, free of charge, in GP surgeries. The idea is that they will work side-by-side with GPs to support with the numbers of MSK patients, by assessing and treating, or triaging to further MSK services, at the first point of contact. Please note that this service is in high demand and there is currently a waiting list. However, please contact us if you are interested.

Educational events

Circle are running education events for GPs and clinicians who would like to learn more about a range of MSK conditions.

Our next education session will be delivered by Dr Sarah Hickton-Burnett, GPwSI with the Greenwich MSK Service:

When: Wednesday 13th March 1-2pm

Where: Eltham Community Hospital, 30 Passey Place, SE9 5DQ

Dr Hickton-Burnett will deliver a GP-centric session on Fibromyalgia: how to diagnose this in primary care; what you can do as primary care physicians; when you should refer on etc.

If you would like more information, or to book your place, please contact greenwichmskevents@circlehealth.co.uk

Clinical Steering Group

This is an evening event for GPs, Consultants, Physiotherapists and other allied healthcare professionals with an interest in MSK, to meet and discuss pathways and ways to improve the service.

The next clinical steering group will be held on:

  • Wednesday 17th April 2019

If you would like to attend, please contact greenwichmskevents@circlehealth.co.uk to which you can also send issues or topics you would like to be addressed at these meetings.

If you have any questions, please contact our team on 0203 893 8382 or by email at Circle.GreenwichGPqueries@nhs.net

Rushcliffe

The Rushcliffe MSK Service, part of Circle Integrated Care, is a single point of access for musculoskeletal conditions.

All patients over 18 years old, who are registered with a Rushcliffe GP, and presenting with an MSK condition, should be sent to the Circle Rushcliffe MSK hub for triage (via e-referrals). This includes patients requiring physiotherapy, but excludes patients presenting with chronic pain or rheumatology conditions.

Referrals will be triaged by specialist MSK Advanced Physiotherapy Practitioner (APP) to the most appropriate treatment modality and patients will be offered a choice of provider, where available. Patients will be monitored and supported across their pathway.

Clinical triage will be performed within 24 hours. If referrals have insufficient information, Circle staff will contact the practice to request further details that will aid an effective triage process.

The Circle MSK Directories of Service was made available on 9th April 2018 and is visible only to CAS. Please continue to direct all relevant referrals through to CAS who will then, in turn, divert appropriately to the below:

  • Podiatry Triage
  • Physiotherapy Triage
  • Orthopaedic Triage
  • Musculoskeletal Triage

These are triage services (RAS) – all patients will be clinically triaged by senior clinicians and then directed on the most suitable treatment pathway.

What conditions are treated?

Circle triages all patients over 18 years old with an MSK condition, excluding those presenting with chronic pain or rheumatology conditions. We offer a variety of treatments and many of our patients are referred onto local MSK services. Areas covered under the MSK service:

  • Orthopaedics
  • Physiotherapy
  • Podiatry (MSK)
  • Podiatric surgery

Patients will be triaged to either:

  • Physioline – Patients will have the opportunity to speak with a physiotherapist who can assess their condition over the phone and can suggest exercises and other management techniques with reference to leaflets and online video demonstrations. If, after assessment, the problem is more complex, face-to-face physiotherapy will be arranged.
  • Physiotherapy – Patients will be referred for face-to-face physiotherapy, and given choice of which provider/location they would like to attend.
  • Community MSK Clinics – Patients will be seen by either an APP or a Consultant depending on their clinical need. During this appointment, they will receive a thorough assessment, have any diagnostics co-ordinated and reviewed, jointly develop a comprehensive treatment plan and complete any onward referrals.
  • Group Physiotherapy –An opportunity for patients to attend a weekly structured rehabilitation class. An experienced physiotherapist will lead the session, ensuring each patient follows a tailored exercise programme that is progressed each week. It will empower patients to have the confidence to self-manage in the long term.
  • Osteoarthritis Education Classes – A chance for patients, and their carers, with a diagnosis of osteoarthritis to attend an education session. Attendees will learn about the condition, how it can result in pain and poorer function and importantly how exercise, self-management techniques, lifestyle changes and advice can lead to reduced pain and improved function.
  • Secondary Care – If a patient requires a secondary care referral, they will be called and offered a choice of provider,. We will also ensure that patients are engaged in shared decision making to ensure they are referred to the most appropriate treatment for them.

What happens when patients leave the service?

When a patient has completed their course of treatment, the Rushcliffe MSK Service will discharge the patient back their GP with a clear discharge plan. The content of the discharge will be structured to allow GPs to identify easily the key steps in a patient’s treatment regime, as well as to understand the interventions completed while under Circle’s care.

Should a patient’s condition require further treatment and onward referral to another allied service, this will be arranged through the Circle MSK hub, and should not require further input from the patient’s GP.

If a patient Did Not Attend (DNA) a hospital MSK appointment:

If a patient has DNA-ed a hospital attendance, Circle will accept direct contact from the patient so they can establish if:

  • their condition has changed;
  • the same pathway is still appropriate;
  • or if a new or different service is available

Circle MSK will then book them an appointment if this is the case.

All referrals should be made to the Circle Rushcliffe MSK service.
If following triage, the patient requires care within a hospital setting (ie surgery), the patient will be called up and offered choice of provider/consultant/location. This ensures patients can still choose where they receive their care.

Yes. The service is designed to support GPs and create integrated working. For example, Circle will be providing MSK Practitioner clinics where experienced physiotherapists will provide front-line clinics, free of charge, in GP surgeries.

The idea is that they will work side-by-side with GPs to support the numbers of MSK patients, by assessing and treating, or triaging to further MSK services, at the first point of contact.

If you have any questions, please contact our team on 0115 671 8885 or by email at MSK.Rushcliffe@nhs.net

40-percent-fewer-waiting-lists
25-decrease-in-inpatient-surgery

The exercises they prescribed made a difference in 3 days and now just over a week after seeing them, the pain is MILES better.

Circle Integrated Care Patient google review