GP Information

What is the new Greenwich MSK service?

The Greenwich MSK Service is a single point of access for musculoskeletal conditions. The new service began on 1st April 2017 – from this date, all patients with an MSK condition registered with a Greenwich GP should be sent to the Circle hub for triage (via E-Referrals).

Referrals will be triaged by specialist MSK Extended Scope Physiotherapists 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.

What conditions are treated?

Areas covered under the MSK service:

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

How do I refer into the service?

The Circle MSK Directories of Service will be available from 1st April 2017 and will be visible only to Greenwich GPs and the RMBS.   The following services can be found on NHS E-Referrals

The service will appear as shown below:

  1. Rheumatology Triage - MSK - Circle Greenwich - NV03A
  2. Podiatry Triage - MSK - Circle Greenwich - NV03A
  3. Physiotherapy Triage - MSK - Circle Greenwich - NV03A
  4. Pain Management Triage - MSK - Circle Greenwich - NV03A
  5. Orthopaedic Triage - MSK - Circle Greenwich - NV03A
  6. Musculoskeletal Triage - MSK - Circle Greenwich - NV03A

Note: These slots are ‘dummy’ clinics – all patients will be diverted to a single point of access for triage by Circle clinicians.

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

What treatment will patients receive?

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 ESP 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.

Will the service support GPs?

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

  • 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.
  • Continuous Professional Learning: Circle will provide education and training opportunities on MSK conditions, based on specific 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.
  • Project Manager: Circle is providing a Project Manager to support primary care projects in Greenwich. This can be for both MSK and non-MSK work.

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 they 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.

Who should I contact?

If you have any questions, please contact our team on 0203 893 8382 or by email at


Questions and answers

Q1. With someone with Rheumatoid Arthritis we refer to the early arthritis clinic at QEH to make sure they get urgent assessment and start treatment. Are you saying we can’t do this anymore and that we need to send patients via circle? Will this cause delays?

From 1 April all referrals should be made to Circle Greenwich MSK Rheumatology Triage (code NV03A). This will ensure that your patient is assessed quickly and that appropriate treatment is initiated without delay, where required. We do not expect this will result in any additional delays and, as the services roll out, we expect waiting times to come down. Circle MSK has a team of staff ready to triage referrals. They are also working in conjunction with the Rheumatology consultants to set up clinics that will run from the hub shortly after service launch to ensure provision of care closer to home.

Q2. If a patient did not attend (DNA) a hospital MSK appointment for whatever reason, are you saying we have to then send through the MSK service again rather than simply re-referring? Or can they simply phone the MSK service to reorganise?

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.

Q3. A patient wants to go to specific hospital for a certain condition. How does the patient exercise choice?

From 1 April all referrals should be made to the Circle Greenwich MSK service. The patient will still have the same rights to choose a hospital as is currently the case. The Circle Greenwich MSK team can advise the patient on their choice.

If a patient has a particular preference for a hospital, the Integrated Provider Hub choice team will discuss this with them and arrange onward referral where the clinical intervention warrants a specialist referral to that provider. If we can provide the treatment locally in the integrated hub, with one of the Extended Scope Physiotherapists or consultants in the hub, we will offer that first as it will not be necessary to travel to the main hospital site.

Q4. Is there a plan for the Circle MSK team to go to practices to explain how the new service will work?

The Circle Greenwich MSK team will be in touch with the all Greenwich CCG practices in the coming days.

Circle has been running a GP engagement road show and can attend your practice if you advise the days and time options that are preferable for you. Please email dates for your availability to