HNY Policy and Pathway Repository - Humber

The provision of timely access to core therapies in the community is essential in supporting this pathway.  Effective self-management with advice and education has been shown to improve long term outcomes and self-efficacy.  Integrated with a Level 2 Advanced MSK Practitioner service including highly efficient one stop shop model working with diagnostic pathways, in-house sonography and injections, patient care is optimised.  The L2 filter makes substantial cost savings and reduces the burden on secondary care.

Red Flags:

• Patients with cauda equina and associated red flags (urgent A&E referral).
• Traumatic Fractures (fracture clinic referral).
• Acute injuries with evidence of significant tendon or neurovascular damage.
• Suspected septic arthritis.
• Cranial arteritis (GCA), systemic vasculitis.
• Acute spinal cord compression.
• Acute Monoarthritis or Polyarthritis.
• Problems associated with joint replacement.
• Limping children/teenagers (suspected slipped femoral epiphysis).
• Suspected musculoskeletal tumours.

Any patients with a high clinical suspicion of cancer or other serious pathology must be sent to secondary care. The 2-week referral pathway must be followed for all patients with suspected cancer and emergency secondary care referral made for other serious pathologies such as cauda equina.

Exclusion Criteria:

• Patients with Red flag symptoms (e.g.) suspected cancer, cauda equina, etc.
• Service users with post-operative or post-traumatic complications.
• Lumps and bumps without previous investigations.
• Suspected fractures, infection, and acute trauma.
• Widespread neurology with or without upper motor neurone signs.
• Chronic pain management.
• Women’s health.

Firstline intervention for MSK conditions should be care navigated and primarily managed with in-house MSK First Contact Practitioners (FCP) without GP / ACP / ANP consultation.  Early identification of serious masquerading pathology and inflammatory conditions are vital and should be excluded from the MSK service.

Referral process:

Clinicians can refer into the service via the preferred NHS e-Referrals method:

• Hull MSK – CATS
• Hull MSK - Physiotherapy

A referral template is available within the Hull ICB S1 reporting unit - If referring via e-Referrals you will need to add this via the communication node, create the referral and attach the letter. Send to: hull.mskservice@nhs.net

Self-referral:

Patients have the option to self-refer via the website: https://www.corahealth.co.uk/locations/yorkshire-and-the-humber/hull/

Telephone self-referral is also possible on: 01482 300003.

Patients under the age of 18 can only access the service via a GP referral.

Core Therapy Services:

• Access to digital self-referral and MSK management.

MSK L1 Physiotherapy.

• Telephone consultation and advice.
• Primary Care management advice.
• MSK L2 Physiotherapy (Orthopaedic, Neurosurgical and MSK Rheumatological opinions +/- POCUS).
• MSK Podiatry.
• Sports & Exercise Rehabilitation.
• Guided and unguided peripheral joint injections (not a standalone process).
• Joint Pain Advisory Clinics (group advice and exercise classes – digital and face to face).
• Single appointment multi team approach including, where necessary, an ultrasound scan.
• Advice, education, and self-management resources.
• Condition management and rehabilitation classes (digital and face to face).
• Links with interfacing community, social care and leisure services.

MSK clinical triage service:

• Patients with complex medical history and nonspecific musculoskeletal symptoms
• Patients who failed with conservative treatments, without clear surgical indication
• Patients who have unclear diagnosis
• Available investigation does not clearly indicate surgery but need advice on management
• Patients who require MSK podiatry assessment and orthotics

L1 MSK Physiotherapy:

• Simple, low acuity, non-complex MSK conditions.
• Available investigations indicate a further trial of conservative treatments.
• Patient willing to engage with or could benefit from MSK Physiotherapy.

L1 MSK Podiatry:

• Patients who could benefit from a MSK biomechanical assessment
• May need devices or short-term orthotics to improve their biomechanical issue.

L2 MSK Physiotherapy:

• Advanced Physiotherapy Practitioner for opinions on Orthopaedic, Neurosurgical or MSK Rheumatology intervention.
• Complex MSK conditions.
• Well managed, Rheumatologically stable, patients with a clear MSK component.
• Patients that may require injection or sonography (ultrasound) in their MSK management.

East Riding Physiotherapy MSK Service is run by CHCP and can be contacted via: http://www.chcpmsk.org.uk/ or call: 01377 208300