Clinical Education


There are over 200 MSK conditions affecting millions of people, including all forms of arthritis, back pain and osteoporosis. The World Health Organisation, (WHO) and Bone and Joint Health strategies Project (2005 cited by the Department of Health) identified that:

  • Up to 30% of all GP consultations are for MSK complaints
  • MSK problems are cited by 60% of people on long term sickness. 40% of the over 70’s have Osteoarthritis (OA) of the knee
  • An estimated 8-10 million of the UK population have arthritis, including 1 million adults under 45 and 70% of 70 year olds
  • 80% of people report low back pain at some point in their life
  • Trauma caused by road traffic accidents (RTAs) will be the third highest ranked cause of disability by 2020

The socio-economic impact is significant and predicted to rise.

The Musculoskeletal  Service Specification draws on guidance from Towards the Best Together (East of England SHA 2008) and the Lord Darzi NHS next stage review – High Quality for All (2008) and the Musculoskeletal Framework (DH 2006).

Aims and objectives of service 

The aim of the service is to provide a comprehensive, patient-centred, and easy to access community MSK service with high quality, efficient service in line with national guidance and local requirements.

The service objectives are:

  • To give patients a choice of where they receive their treatment
  • To provide improved access to care closer to home
  • To reduce waiting times to access the service and deliver treatment to enable patients to reach their individual treatment goals sooner. The service should aim to improve Patient Quality of Life, including the ability to return to work and improved pain management.
  • To ensure that all patients receive treatment according to their clinical need.
  • To deliver clinically effective treatments that reduce the demand on secondary care (acute) services and reduces the need for more costly interventions
  • To provide community services that have a strong emphasis on patient education and self-management, thereby promoting active, healthy lifestyles and reducing recurrence of injury or illness
  • Provide feedback, advice and guidance via phone, email and face to face for referring clinicians as to how conditions can be managed within primary care where appropriate, or provide advice and guidance on requests to encourage and promote up-skilling in primary care
  • Assess clinically and refer backward patients who may be managed by their own GP practice in primary care
  • Provide a holistic, one-stop (where appropriate) service for patients
  • To operate well planned and clearly articulated care pathways, covering the defined presentations and conditions and delivering safe, evidence-based care
  • To ensure each patient sees a person with relevant skills, using the right equipment, in a suitable location
  • To deliver the shortest pathway possible, compatible with best patient outcomes
  • To deliver an integrated service which works closely with other service providers across the local healthcare system maximising efficiencies and delivering high quality care
  • To improve the patient experience by reducing Did Not Attend (DNA) and cancellations

Service description / care pathway 

The Community MSK service shall offer patients a choice of sites and access to specialist treatment within the local community.

The service shall cover the range of MSK problems common to primary care. These include, for example, but are not limited to:-

Upper Limb:
Hand & Wrist, Elbow, Shoulder

Lower Limb:
Foot and Ankle, Knee, Osteoarthritis (OA), Hip, Rheumatology

Back and Neck:
Assessment and treatment of back and neck pain for patients who do not require specialist intervention.

Referrals shall be triaged in a community setting, with patients being seen and managed within the Community Physiotherapy service, or referred on to other appropriate services, as necessary.

The service shall complete a thorough history and undertake physical assessment of patients with suspected MSK disorders. Following assessment, the Provider shall document a Patient Care Plan.

Signposting to various pathways and services 

OA Hip and Knee
Patients diagnosed with OA Hip shall be assessed and treated as directed by the OA Hip pathway specified (see the Hip Pathway section of the website).

Patients diagnosed with OA Knee shall be assessed and treated as directed by the OA Knee Pathway (see the Knee Pathway section of the website)

Back and Neck Service
Patients diagnosed with back pain shall be assessed and treated as directed by the Back and Neck Service (BaNS) –see the Spinal Section of the website

Female Continence
Female patients requiring specialist advice and treatment for incontinence shall be assessed and treated as directed by the Female Continence pathway (see the Women’s health Pathway section of the website)

Referral Process 

For GP or other Healthcare Professional referrals, if you feel your patient needs to see a Physiotherapist, please hand them a self referral card to complete their details either on line or over the phone, or ask the patient to refer themself via a self-referral system.

GPs shall be provided with a card containing the service contact details. This shall be given to patients that agree to self-refer following a GP practice consultation.

Patients with MSK conditions shall access the self-referring system via a web based portal or by telephone.