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 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.

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 Circle MSK Directories of Service is available and is visible only to Greenwich GPs and the RMBS. 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

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

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?

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.

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?

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.

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 have been visiting the Greenwich CCG practices over the last few months, if you feel that another visit may be beneficial please let us know.

Please email dates for your availability to the Circle’s Project Support in Greenwich.

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

Clinical Steering Group

This is an evening, on the second Wednesday of each month, for clinicians with an interest in MSK to meet and discuss pathways and ways to improve the service. Meeting dates for this year include:

  • Wednesday 9th May 2018
  • Wednesday 13th June 2018
  • Wednesday 8th August 2018
  • Wednesday 12th September 2018
  • Wednesday 10th October 2018

If you would like to attend, please contact 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