Musculoskeletal services in Bedfordshire, Greenwich, North Hampshire, Rushcliffe and S&W Hertfordshire
In partnership with the
Musculoskeletal services
Below is an overview of our musculoskeletal (MSK) services, but you can expand the section for your own area for more detailed local information.
Each MSK service provides a single point of access for MSK conditions, for patients registered with GPs in the areas shown.
Clinical triage of referrals is carried out by specialist MSK clinicians, within 24-48 hours, to the most appropriate treatment pathway. If referrals contain insufficient information, we will contact the referring practice to request additional information, explaining what we need and why.
If any concerning symptoms have been flagged within a self-referral, our triaging clinician may contact the patient to discuss these, and may recommend that they contact their GP or urgent care service if appropriate.
Patients will be monitored and supported throughout their pathways, until completion of treatment. Should a patient’s condition require further treatment, and/or onward referral to another allied MSK service, this will be arranged through the Circle MSK hub and should not require further input from the patient’s GP.
From triage, patients could be assigned to any of the following:
Physioline
For low-complexity, low impact MSK conditions. Video (or telephone) appointment with a physiotherapist who will assess the patient’s condition and suggest exercises and other management techniques to help, using leaflets and online video demonstrations which are usually sent via email. For more complex problems, face-to-face physiotherapy can be arranged after this call if needed.
Group or digital rehab/physiotherapy
For mild to moderate severity and impact on function. Digital option of Joint Academy (for more information click here: [link to Joint Academy page]; or face-to-face group rehab classes or ESCAPE-pain (education and exercises for osteoarthritis) classes.
Face-to-face individual rehab/physiotherapy
For higher severity and impact on function, or limited/no success with group/virtual options.
Community MSK Clinics
For higher complexity cases, or those needing further investigation. Virtual or face-to-face assessment with an Advanced Physiotherapy Practitioner (APP) or GP with extended role in MSK medicine (GPwER). Patients will be thoroughly assessed, have any diagnostics arranged and/or reviewed, and develop a comprehensive onward treatment plan in partnership with the clinician.
Diagnostic Pathway
If sufficient clinical information is provided in the referral, some patients may have diagnostics arranged directly from triage without needing to see an APP first.
Direct referral to secondary care
If appropriate (e.g. meeting surgical thresholds) and if full work-up completed. Suspected inflammatory arthritis will be sent straight on to rheumatology.
Please note that we manage patients on a single pathway, and cannot arrange multiple different treatment modalities at the same time.
Depending on a patient’s MSK condition, and the service they require, there may be a number of options to choose from, or only one. Patients are given a choice of provider, location and date/time wherever possible. We encourage patients to tell their GP/referrer if they have particular preferences, so that they can be included on the referral, but we are always happy for patients to contact us to discuss their options.
Digital management options include video calls and delivery of physiotherapy management via apps or online platforms, such as the Joint Academy app. These don’t suit everyone but, where appropriate, can be great for some patients – transformative, even, for those who might struggle to attend face-to-face (F2F) for any reason, such as work or caring responsibilities. The results of these digital options are excellent and comparable to F2F options.
If your patient is digitally able, we encourage you to let us know on your referral. Please be reassured that if patients indicate that they don’t wish to proceed with a virtual option, they will always be returned to us and we will arrange an alternative F2F option.
We urge patients to contact the clinic they’re booked with (contact details are included with appointment information) as soon as possible if they’re unable to attend their appointment. If a patient DNAs twice without contact or reason, they will usually be discharged back to their GP (unless this is considered to be clinically inappropriate, in which case we may contact the patient to offer a further appointment).
Patients who do not attend an appointment in secondary care will be subject to the individual provider’s DNA policy, which Circle cannot influence.
When a patient has completed their course of treatment, Circle will discharge the patient back to their GP with a clear discharge plan.
When clinically appropriate, a PIFU (patient initiated follow up) period will be set up: this usually ranges between 3-6 months but could be longer if clinically necessary. If the same problem recurs within that timeframe, the patient can contact Circle directly and we will reinstate their referral.
Red flags:
- Suspected fracture or infection – refer to local A&E (or fracture clinic if appropriate)
- Suspected Cauda Equina Syndrome – refer to local A&E
- Undiagnosed lumps and bumps – please arrange appropriate imaging and/or refer to appropriate service locally
- Suspected cancer – please use the most appropriate local 2WW pathway (or local rapid diagnostic clinic where available)
Non-MSK conditions:
- Neurological disorders
- Falls
- ENT disorders e.g. vertigo, TMJ disorders
- Gynaecological referrals e.g. women’s health, incontinence
- Non-MSK podiatry e.g. corns, toenails, callouses (MSK podiatry is included)
Domiciliary physiotherapy – we are unable to arrange home visits.
We do not accept referrals containing red flags, as per the criteria above.
If we see a patient and suspect they may have cauda equina syndrome or an infection, we will advise them to attend their local A&E and we will provide clinical paperwork for them to take with them.
Very occasionally, diagnostic test results come back indicating a suspicion of cancer. We are unable to make referrals on 2WW pathways from the MSK service so need to hand care over to the patient’s GP surgery. In this case, one of our senior clinicians will contact the patient’s GP surgery on the day they review the results and speak with the patient’s GP or the duty doctor, explaining the findings. All relevant documentation will be shared with the GP surgery. GPs usually choose to speak with the patient themselves, rather than the MSK clinician, but that responsibility would also be discussed during the conversation.
If, after further investigation, cancer is ruled out but the original MSK condition persists, we will be happy to accept a new referral (obviously including explanation of the above).
Musculoskeletal service locations
What are the inclusion/exclusion criteria, and which specialities are covered by the Bedfordshire MSK service?
We accept referrals for patients with an MSK condition who are registered with a Bedfordshire GP and who are aged 18 years or over.
Please see the exclusion criteria listed above. In addition, we don’t accept referrals for chronic fatigue syndrome or non-MSK chronic pain.
The following specialities are covered by the MSK service:
- Physiotherapy
- Orthopaedics
- Pain Management
- Rheumatology
- Podiatry (MSK only)
- Podiatric Surgery
How are patients referred to the MSK service?
All MSK referrals from primary care should be submitted using the MSK referral form on SystmOne and sent to us by clicking the button at the end of the referral form.
Patients can also self-refer to the MSK service using our online digital assessment tool Phio.
Are there any additional services which can be offered following initial assessment?
Yes, where appropriate we can offer:
- Shockwave therapy
- Corticosteroid joint injections +/- ultrasound guidance
- In-house chronic pain MDT
- In-house rheumatology MDT
Where do patients need to go to be seen?
Please visit our Bedfordshire page to see a list of local clinics and the services which are usually available at each. Please note that not all locations will be appropriate for all patients.
Who do I contact if I have any queries – clinical or administrative?
If you have any administrative questions including appointment updates, waiting times etc. please email [email protected]or call 01234 639000.
If you have any clinical questions, please email [email protected]
What are the inclusion/exclusion criteria, and which specialities are covered by the Greenwich MSK service?
We accept referrals for patients with an MSK condition who are registered with a Greenwich GP and who are aged 18 years or over.
Please see the exclusion criteria listed above. In addition, we don’t accept referrals for chronic fatigue syndrome or non-MSK chronic pain.
The following specialities are covered by the MSK service:
- Physiotherapy
- Orthopaedics
- Pain Management
- Rheumatology
- Podiatry (MSK only)
- Podiatric Surgery
How are patients referred to the MSK service?
All MSK referrals from primary care should be submitted using the up-to-date MSK referral form on DXS and sent to Circle via eRS. Please ensure that you use the form on DXS and not any old forms which may be downloaded and saved locally – the referral form may be updated from time to time and will always be current and available on DXS. Referrals on old forms will be rejected at triage.
Patients can also self-refer to the MSK service using our online digital assessment tool Phio.
Are there any additional services which can be offered following initial assessment?
Yes, where appropriate we can offer:
- Shockwave therapy
- Corticosteroid joint injections +/- ultrasound guidance
Where do patients need to go to be seen?
Please visit our Greenwich page to see a list of local clinics and the services which are usually available at each. Please note that not all locations will be appropriate for all patients.
Who do I contact if I have any queries – clinical or administrative?
If you have any administrative questions including appointment updates, waiting times etc. please email [email protected] or call 020 3893 8382.
If you have any clinical questions, please email [email protected]
What are the inclusion/exclusion criteria, and which specialities are covered by the North Hampshire MSK service?
We accept referrals for patients with an MSK condition who are registered with a North Hampshire GP and who are aged 16 years or over.
Please see the exclusion criteria listed above. In addition, we don’t accept referrals for chronic fatigue syndrome or non-MSK chronic pain.
The following specialities are covered by the MSK service:
Physiotherapy
• Orthopaedics
• Podiatry (MSK only)
• Onward referral for Podiatric Surgery, within new Procedures of Low Clinical Value guidelines (i.e. not hallux rigidus or bunion surgery)
How are patients referred to the MSK service?
All MSK referrals from primary care should be submitted using the MSK referral form on EMIS and sent to Circle via eRS.
Patients can also self-refer to the MSK service using our online digital assessment tool Phio.
Are there any additional services which can be offered following initial assessment?
Yes, where appropriate we can offer:
- Shockwave therapy
- Corticosteroid joint injections +/- ultrasound guidance
- Nerve Conduction Studies
Where do patients need to go to be seen?
Please visit our North Hampshire page to see a list of local clinics and the services which are usually available at each. Please note that not all locations will be appropriate for all patients.
Who do I contact if I have any queries – clinical or administrative?
If you have any administrative questions including appointment updates, waiting times etc. please email [email protected] or call 01256 869401.
If you have any clinical questions, please email [email protected]
What are the inclusion/exclusion criteria, and which specialities are covered by the Rushcliffe MSK service?
We accept referrals for patients with an MSK condition who are registered with a Rushcliffe GP and who are aged 18 years or over.
Please see the exclusion criteria listed above. In addition, we don’t accept referrals for chronic fatigue syndrome or non-MSK chronic pain.
The following specialities are covered by the MSK service:
- Physiotherapy
- Orthopaedics
- Pain Management
- Podiatry (MSK only)
- Podiatric Surgery
How are patients referred to the MSK service?
All MSK referrals from primary care should be submitted using the MSK referral form on EMIS and sent to Circle via eRS.
Patients can also self-refer to the MSK service using our online digital assessment tool Phio.
Are there any additional services which can be offered following initial assessment?
Yes, where appropriate we can offer:
- Corticosteroid joint injections
Where do patients need to go to be seen?
Please visit our Rushcliffe page to see a list of local clinics and the services which are usually available at each. Please note that not all locations will be appropriate for all patients.
Who do I contact if I have any queries – clinical or administrative?
If you have any administrative questions including appointment updates, waiting times etc. please email [email protected] or call 0115 671 8885.
If you have any clinical questions, please email [email protected]
What are the inclusion/exclusion criteria, and which specialities are covered by the South and West Hertfordshire MSK service?
We accept referrals for patients with an MSK condition who are registered with a South and West Herts GP and who are aged 18 years or over.
We also accept referrals for children aged 8-18 for MSK rehab physiotherapy ONLY. All other MSK referrals for children should be sent directly to the appropriate provider. Please note that our APPs cannot assess any paediatric patients so any child (potentially) requiring diagnostics and/or onward referral to secondary care will have to be referred back to primary care.
Please see the exclusion criteria listed above.
The following specialities are covered by the MSK service:
- Physiotherapy
- Orthopaedics
- Pain Management
- Rheumatology
- Podiatry (MSK only)
- Hand Therapy
- Podiatric Surgery
- Chronic Fatigue Syndrome diagnosis and management
How are patients referred to the MSK service?
All MSK referrals from primary care should be submitted using the up-to-date MSK referral form on DXS and sent to Circle via eRS. Please ensure that you use the form on DXS and not any old forms which may be downloaded and saved locally – the referral form may be updated from time to time, and will always be current and available on DXS. Referrals on old forms will be rejected at triage.
Are there any additional services which can be offered following initial assessment?
Yes, where appropriate we can offer:
- Shockwave therapy
- Corticosteroid joint injections +/- ultrasound guidance
- In-house chronic pain MDT
- In-house rheumatology MDT
Where do patients need to go to be seen?
Please visit our South and West Hertfordshire page to see a list of local clinics and the services which are usually available at each. Please note that not all locations will be appropriate for all patients.
What happens when a patient leaves the MSK service:
All SWH patients are given a 6-month PIFU period. If the same problem recurs within that timeframe, the patient can contact Circle directly and we will reinstate their referral.
Who do I contact if I have any queries – clinical or administrative?
If you have any administrative questions including appointment updates, waiting times etc. please email [email protected] or call 01442 500985 .
If you have any clinical queries, you can either:
- Submit a question via the advice and guidance (A&G) function on eRS
OR
- Contact our admin team by email/phone as above, who will pass your query to the clinical team.
Very good MSK arthritis course, for learning how to cope with arthritis pain. Exercises to build up muscles round your joints, and information on coping strategies, plus encouragement to approach movement and exercises with a more positive mindset.
Circle Integrated Care patient Google review