Empowering patients to digitally self-refer into muskoskeletal services

My Topol fellowship problem / project:

Most musculoskeletal (MSK) problems are not due to serious pathology (damage or disease) so the traditional arrangement of requiring GPs to refer to a MSK service in order to get help creates 2 problems:

  1. A significant burden on GPs – 30% of GP consultations are for MSK conditions, many (not all) of which require onward referral. Camden MSK receives approximately 100 referrals per day.
  2. The medicalisation of simple conditions and reduction of patient empowerment which reduces ability to manage the condition, leading to worse outcomes and increased reliance on healthcare.

Anything which may reduce GP appointments and associated workload for MSK conditions and increase empowerment should therefore be explored. Reducing face-to-face consultations is also desirable from a public health perspective due to COVID-19. People increasingly expect digital solutions in all aspects of life including healthcare, so current access arrangements to the Camden MSK service must modernise.

My proposal is to design and embed a digital self-referral portal into our website, offering access to the entire MSK pathway – Podiatry, Camden Pain Service, Physiotherapy and CATS (Clinical Assessment and triage Service) with neurosurgery, orthopaedics and rheumatology via CATS. A decision tree will automate some triage decisions, reducing Camden MSK administrative, triage and GP workload. Relevant comprehensive patient information will be pushed, and urgent care services signposted where necessary. Digital self-referral to the integrated MSK service, unlimited across the locale, with self-management information would deliver significant improvement to patient access, experience and empowerment, and possibly to Camden MSK efficiency, which is consistent with modern digital expectations.

I am Clinical Lead for a team of Advanced Physiotherapy Practitioners (APPs) in Camden, with additional leadership responsibility to the wider MSK service. I have been an APP in the NHS for over 10 years, after various traditional NHS Physiotherapy roles. I recently conducted a review of access and provision for the MSK service, which led to the conception of my project.

I am particularly interested in referral triage and am involved in a number of projects to evaluate and optimise the triage process, particularly in the COVID-19 era with the need to stratify patients for face-to-face, digital or telephone consultations. My experience to date of digital projects is that there is a risk that considerations of impact on patients (positive and negative) can be secondary to those of operational efficiency and clinical information synthesis. I am therefore very keen to ensure that all stakeholders, and patients in particular, are at the centre of the digital projects I am involved with.