1. GP Training Event Primary Care - MSK messages 12-11-2015 Mr
GP Training Event Primary Care - MSK messages Mr. David Cumming – Ipswich Hospital - Spinal Consultant Dr John Flather - IESCCG - Dean Onno – IESCCG – Transformation Lead

2. Spinal messages for Primary Care
KEY MESSAGE : All spinal referrals should be to community MSK who can onward refer to BANs except…
...Red flags! Send via e-referral (Choose & Book) to acute with:-
A.L.L. form completed (ticked) and attached
Referral details attached (letter)
There should not be ANY posted letters or faxes to Spinal team. Use eReferral with ALL form + letter attached!
There will be “push back” of referrals where ALL / letter not attached or completed
Please do not to send spinal patients as walk in patients to the fracture clinic. The patients will not be seen by the orthopaedic consultant running the fracture clinic. If the patient needs to be seen urgently make a referral via the spinal ALL
Community Physiotherapy
IHT + AHP – Community Physiotherapy + OA Hip/Knee pathway – Card holders put into practices for both IHT/AHP
Direct referral to BANs is possible but this is not pathway.

3. IESCCG - High level MSK referral routes
SPINAL
GP spinal
referral
Community Physio
RED FLAG
Complete ALL Form
Send via eReferral
BANS / MDT
Secondary Care

4. COMMUNITY PHYSIOTHERAPY CHANGES
Procurement completed February 2015 with two providers for this service.
Ipswich Hospital (currently 5 sites)
Ivry street, Needham Market, Stowhealth, Wickham Market and Felixstowe Haven Health
Allied Health Professionals (currently 13 sites)
Aldeburgh Cottage Hospital, Eye - Hartismere Hospital,
Framlingham GP practice, Fressingfield GP practice,
Felixstowe Community Hospital, Grundisburgh GP practice,
Hadleigh Health Centre, Ipswich – Chantry Clinic,
Ipswich – Riverside Clinic, Ixworth GP practice,
Otley GP practice, Stowmarket – Stow Lodge Centre,
Wickham Market GP practice
Patient Choice
Card holder in reception

5. ORTHOPAEDICS CHANGES
The Ipswich Hospital MSK ESPs (formerly know as MCAS) role has changed:-
ESPs working from community locations as of July ‘15
ESPs no longer triaging acute orthopaedic referrals
ESPs accessed via community physiotherapy
Aim is to push more MSK work back to the community physiotherpay services
Consultants (not MCAS) now triage Orthopaedic ALL
Clinical Review Nurses are reviewing all Orthopaedic clinical threshold referrals before the first outpatient (Gateway 1) and after (Gateway 2)
KEY Message: Threshold referral paper work must be completed.

6. KEY MSK MESSAGES for Primary Care
Refer all MSK patients to the community Physiotherapy services except…
...Red Flag patients who should be referred directly to Orthopaedic ALL (Upper, Spinal, Lower…)
The list of non-spinal Red Flag conditions is being worked up and will soon be available on Map of Medicine
Issues around “Nerve Conduction Studies”. Are your patients being onward referred for a Carpal Tunnel procedure?
NB. Nerve Conduction studies are not part of the Carpal Tunnel Pathway

7. GP MSK referral Community Physio RED FLAG ESP Secondary Care
IESCCG - High level MSK referral routes
Orthopaedics (Non-Spinal)
GP MSK
referral
Community Physio
RED FLAG
Complete ALL Form
Send via eReferral
ESP
Secondary Care

8. Finally How get MRI for patient? Whiplash patients route?
Hand conditions route?
Acute knee clinic has criteria – Injury < 3weeks old, Patient < 45 typically sporting injury