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Serious pathology in the absence of an obvious cause (eg trauma) is very rare, but be aware of signs suggestive of more serious pathology.
If suspected tumour - refer via 2ww
If the patient is still under consultant care post-operatively any issues relating to post-operative recovery should be referred back to the consultant
Refer to the Trauma Triage Service or A&E for suspected fracture
NB: Be aware that some red flags have very high false-positive rates and as such have little diagnostic value in primary caresettings. Careful clinical judgment to decide whether to investigate further or refer is needed.
Many patients with spinal problems can, with advice and guidance, manage their problems without additional support. Please see the individual conditions for specific guidance.
See the Core Physiotherapy Services section below for patient self-referral information, printable posters and business cards.
Consider using risk stratification (for example, the STarT Back risk assessment tool) for each new episode of low back pain with or without sciatica to inform shared decision-making about stratified management.
STarT Back Risk Stratification is a prognostic 9-point screening tool to be completed with the patient by GPs and First Contact Practitioners; it is a key feature of the National Low Back Pain & Radicular Pain Pathway and NICE NG59 (Risk Assessment and Risk Stratification Tools 1.1.2 and 1.1.3). STarT Back generates an overall score and psychosocial subscore that divides patients into low, medium and high risk of developing persistent back pain-related disability thus indicating one of the three appropriate targeted treatment pathways.
Full details of STarT Back including online training can be accessed via http://www.keele.ac.uk/sbst/. A brief video has been produced looking at the use of STarT Back in practice and is available to watch here; https://youtu.be/r9wEgy4La4o
Please also see the Clinician Education Section here for the STaRT Back E-Learning package.
Based on risk stratification, consider:
MSK Specialist Triage will decide on the appropriate management pathway for your patient based on the information in your referral. Further details about Specialist Triage are below.
Core and MSKAPS services operate an eight week waiting time target for routine appointments, and two week waiting time targets for urgent appointments.
Access to an Orthopaedic opinion for any adult Spinal problems is through the MSK Specialised Triage (APS and Orthopaedics) - Adults only. GHNHSFT triage patients within the Gloucester and Cheltenham localities, and GCS triage the five other localities. The two organisations are working closely together to ensure consistency and standardisation of approach.
Direct referral to Orthopaedics for children remains as it currently is.
Triage of adult elective care referrals is an NHS England mandated change that is fully supported by Gloucestershire’s lead orthopaedic consultants.
All MSKAPS and Orthopaedic referrals should be made to 'MSK Specialist Triage' on eRS. This is the only way of accessing Orthopaedics for patients registered with a Gloucestershire GP.
As part of the agreed, countywide strategy, all referrals must be made via e-RS (electronic Referral system). More information on paper referral switch off can be found, here.
The effectiveness and accuracy of triage depends on the quality of information given by the referrer. The MSK referral form outlines the information required by Specialist Triage and by Secondary Care to decide how to manage a patient appropriately. The MSK referral form has been formatted to auto-populate patient’s data (name, date of birth, etc.) in all clinical systems, saving administrative time.
Please follow these links for further information;
Contact details for the MSK Specialist Triage Services can be found here.