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 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 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 in to a “dummy” slot, therefore please do not print off the e-RS booking letter.

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 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 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.

Rheumatoid arthritis patients are usually referred to the early arthritis clinic at QEH to make sure they get an 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?

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.

If a patient did not attend (DNA) hospital MSK appointment(s) and has been discharged, will we have to re-refer through the MSK service again or can they phone the MSK service to reinstate?

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 a 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.

Useful MSK related links

Document Published Web link Description
Spinal GIRFT January 2019 https://gettingitrightfirsttime.co.uk/surgical-speciality/spinal-surgery/ 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 https://www.england.nhs.uk/wp-content/uploads/2018/06/04-b-pb-04-07-2018-ebi-consultation-document.pdf 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 https://www.england.nhs.uk/ourwork/clinical-policy/ltc/our-work-on-long-term-conditions/musculoskeletal/ Update on MKS conditions with a link to Arthritis and MSK Alliance (ARMA)
Everybody active every day October 2014 https://www.england.nhs.uk/ourwork/policy/ltc/our-work-on-long-term-conditions/musculoskeletal/  Update on MSK conditions with a link to Arthritis and MSK Alliance (ARMA)

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