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 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 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, exluding 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
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, and given choice of which provider/location they would like to attend.
  • Community MSK Clinics – Patients will be seen by either an Extended Scope Practitioner (ESP) 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, will we have to send through the MSK service again rather than re-referring? Or can they phone the MSK service to re organise?

If a patient has DNA-ed a hospital attendance, Circle will accept a 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.

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

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 with 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

Useful MSK related links

Document Published Web link Description
Spinal GIRFT January 2019 This document looks at evidence based commissioning for spinal services and forms the basis for our referral pathways for spinal conditions
Evidence Based Interventions Consultation Document July 2018 Provides a guideline to evidence based management of a number of commonly commissioned procedures including knee arthroscopy, injections for back pain, shoulder arthroscopy and a variety of hand clinicians
Musculoskeletal Conditions Update on MKS conditions with a link to Arthritis and MSK Alliance (ARMA)
Everybody active every day October 2014  Update on MSK conditions with a link to Arthritis and MSK Alliance (ARMA)