Humber NHS Foundation Trust. Joint Effort

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1 Joint

2 Joint is a new community based musculoskeletal service that treats patients with complex problems of the spine, upper and lower limb. Joint s experienced Consultant Orthopaedic Surgeons and Extended Scope Practitioners provide thorough assessment, diagnostics and management of conditions tailored to individuals needs. The team help patients to understand their condition, prevent recurrences and learn how to actively manage it. Orthopaedic Surgeon Fast Local Access Direct Listing Extended Scope Practitioner Who should be referred to Joint? Patients presenting with complex spinal, upper and lower limb problems who would previously have been referred to secondary care. Patients that may not require surgery but who need an expert opinion or intervention. The service welcomes referrals from GPs in Bridlington. Helen Cammish Clinical Services Manager Injections Investigations Patients who may be a potential for surgical intervention but fall outside the Amber and Red criteria on the algorithm on the following page. Patients who have had little or no benefit from recent, appropriate physiotherapy intervention. Patients with a recurring history or episodes of musculoskeletal problems who have not responded to mechanical therapy.

3 Joint Algorithm - A referral guide for patients presenting with MSK conditions Referral to Community Care Consider use of diagnostics in Primary Care to screen Referral to Secondary Care Consider use of diagnostics in Primary Care to screen LEVEL ONE PHYSIOTHERAPY SERVICES Patients not meeting the red or amber criteria with routine / first episode / previous good outcome with Physiotherapy Post surgery/ post fracture rehabilitation Simple soft tissue injuries Mechanical low back pain Assessment for walking aids Pelvic girdle pain in pregnancy JOINT EFFORT A patient presenting with a complex spinal, upper limb and lower limb MSK condition whom you would have previously considered referring to secondary care A patient who may be a potential surgical candidate but falls outside of the Amber and Red (Red flag Pathology) sections of the Joint algorithm A patient that has had little or no benefit from recent appropriate MSK Physiotherapy A patient with history of recurring episodes that have failed to respond effectively to mechanical therapy A patient not suitable for physiotherapy, that may not need surgery but requires an expert orthopaedic diagnosis URGENT Cauda Equina: sphincter disturbance, gait disturbance, saddle anaesthesia (refer to A&E or on-call Neurosurgeon) Suspicion of infection in joint including prosthetic joint (refer to A&E orthopaedic if prosthetic SOON Severe unremitting radicular pain uncontrolled by opiate analgesia sciatica, brachalgia (refer via fax/phone call within 1/52 to Neurosurgery) Inflammatory back pain (refer to Rheumatology) Suspected persistent synovitis of unknown cause, connective tissue disease vasculitis (refer to Rheumatology) joint or rheumatology or neoplasm (refer to A&E if Acute or Oncology)) Violent, significant trauma (refer to A&E) Rapid progressive neurological deterioration e.g. foot drop (refer via fax/phone call to oncall Neurosurgeon) Traumatic knee suspected haemarthrosis true locking (in extension), true give way, traumatic shoulder instability, rupture of weight bearing tendon, tendo-achilles, quadriceps (refer Orthopaedics) Complex regional pain syndrome (refer to Specialist Secondary Care Pain Service) ROUTINE Spinal myelopathy, cord compression (refer to Neurosurgery) Unidentified inflammatory syndrome (refer Rheumatology) OA knee with Varus / Valgus deformity or >65 / severe OA hip willing/fit to have surgery / recurrent shoulder instability (refer to Orthopaedics)

4 Referral to Secondary Care (Urgent) A&E Services provided Patient GP Referral to Secondary Care (Soon / Routine) Single Point of Access Triage Administration Clinical Joint Orthopaedic Surgeon Extended Scope practioner Assessment Diagnosis Intervention Management Diagnostics Orthopaedics Neurosurgery Rheumatology Pain Clinic Direct Listing Patient referral letters will be triaged with reference to the algorithm on the previous page. Following paper triage, patients will be allocated as follows: referral to mainstream physiotherapy referral to Joint service and an appointment made with either an Orthopaedic Consultant or Extended Scope Practioner. referral to other Community Service or secondary care services such as Rheumatology Following assessment in the clinic, patients will be discharged with one/ more of the following outcomes: diagnostic tests and interpretation Referral to Community Services advice and care plans including exercises treatment intervention e.g. joint/soft tissue injection Physiotherapy Podiatry Neighbourhood Care Team Pain Service Specialist Paediatric Services Discharged referral to mainstream physiotherapy or other community service direct listing for surgery referral to secondary care service e.g. rheumatology

5 Map illustrating our service availability and the location of clinics in the East Riding of Yorkshire Refer to Joint By letter or referral form to: Joint Physiotherapy Department Bridlington District Hospital Bessingby Road Bridlington YO16 4QP By Choose and Book (under Speciality/Orthopaedics) By electronic referral (NHS Mail) By Fax Only through feedback from yourselves and patients can we be sure that this service meets expectations and identify which areas may require improvement or change. Contact us Telephone: More information Website.