The Bedfordshire MSK Service is a single point of access for musculoskeletal conditions.

The new service began on 1st April 2014. From this date, all patients over 18 years old with an MSK condition registered with a Bedford GP should be sent to the Circle Hub for triage (preferably 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.

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

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 are referral are through:

Fax: 01234 639001

The Enhanced Services Centre
3 Kimbolton Road
MK40 2NT

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

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.

What conditions are treated?
Areas covered under the MSK service:

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

If a patient did not attend (DNA) a hospital MSK appointment for whatever reason, will we have to send through the MSK service again rather than re-referring? Or can they 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.

A patient wants to go to a specific hospital for a certain condition, how does the patient exercise choice?

From the 1st of April, all referrals should be made to the Circle Bedford MSK service. The patient will still have the same rights to choose a hospital as is currently the case. The Circle Bedford 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.

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.

Educational events

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

If you would like more information, please contact Tom Billers, Circle’s Service Transformation Project Manager in Bedfordshire, at

Clinical Steering Group

This is an evening for clinicians with an interest in MSK to meet and discuss pathways and ways to improve the service. The dates for 2018 are as follows:

If you would like to attend, please contact You can also send issues or topics you would like to be addressed at these meetings.

Clinical Steering Group meetings on a Thursday are located at Flitwick Manor, Church Road, Flitwick, MK45 1AE – 0330 028 3406. Those on a Wednesday are located at The Embankment, Bedford, MK40 3PD – 01234 261332.

  • Wednesday 30/05/2018
  • Thursday 28/06/2018
  • Wednesday 25/07/2018
  • Thursday 30/08/2018
  • Wednesday 26/09/2018
  • Thursday 25/10/2018
  • Wednesday 28/11/2018

If you have any questions, please contact our team on 01234 3690002 or by email at