Keeping my finger on the pulse of this situation. NHS England pushes MSK triage system which leads to rejected GP referrals.
NHS England has encouraged use of a triage system for the musculoskeletal (MSK pathway which explicitly allows rejection of GP referrals in a bid to "optimise capacity". New guidance on MSK 'referral optimisation", published last week, pushed the use of advice and guidance, as well as 'referral assessment services', (RAS).
They are rejecting GP referrals for patients to see Orthopaedic consultants to reduce waiting lists, and it is clearly a cost-cutting exercise too. However, patients have been complaining about the MSK pathway for years. Especially the so-called Physiotherapy sub-contractors.
I write this because I care about all patients that are suffering, patients that are not receiving the help that they require from NHS England.
This is an example of real experience in 2022 and 2023.
Case 1
GP refers patient to MSK pathway to find out if an x-ray of the left arm is necessary.
Months later patient given an appointment with a so-called Physio and Muscular & Skeletal Department.
Practitioner gives patient exercise sheets and says he will call in a month for a review appointment.
Patient doesn't hear from the practitioner again. Patient still in pain.
Patient pays privately to see a Chiropractor and the experienced Chiropractor doesn't agree with the diagnosis of the so-called Physiotherapist.
Patient complains to GP surgery about the MSK service, manager of GP surgery requests a letter from the Chiropractor sent to the GP.
Patient makes a complaint to Trading Standards because handing out exercise sheets is not hands on Physiotherapy. Has such, NHS England is in contravention of the law of the land.
Case 2
Patient in severe pain and unable to put any weight on left leg. Patient phones NHS 111. NHS 111 send out community nurse and paramedic the same day. Community nurses say it is a ligament injury and telephones the surgery for a strong pain-killer prescription.
Pharmacy refuses the prescription and tells patient that the manufacturers have stopped manufacturing capsules.
Appointment with GP to get a new prescription, GP referral to in-house Physiotherapist. The so-called physiotherapist doesn't examine the patient, doesn't give a diagnosis for the arm or the leg injury. Hand's out paperwork with exercises.
Case 3
GP refers patient for MRI of the neck. Spur found. Muscular and Skeletal Department, offer a choice of steroid injections, operation or pilates at the so-called Physiotherapy Department. Another sub-contractor that patients have been complaining about for years.
Patient attends Pilates with the intention of improving core muscles. Due to the teacher not taking into account the conditions of individual patients. Two patients in the class were worse off than prior to the class. Teacher takes offence when told the truth. Practitioner throws one of the patients out of the class and says patient has to have one-to-one attention. A few classes later, another patient with a severe back condition leaves the class for the same reasons.
Months later, another appointment with the same sub-contractor. Remember it is supposed to be one-to-one, Physiotherapy. When the patient asks why they aren't receiving any Physiotherapy, practitioner responds, "too many patients and not enough time".
Another line said to patients when they don't receive any Physiotherapy: "We are not allowed to touch you".
Is the MSK triage pathway working for patients? Definitely not. Is the so-called "Physiotherapy" service working for patients? Certainly not.
Case 4
GP refers patient to see Neurologist due to his concerns. Waiting list 8 months.
So what can you do?
Send complaint letters to the following:
NHS England.
Minster for Health, Victoria Atkins MP
Quality Care Commission
Your local MP
Your local Clinical Commissioning Group
Your County Councillors, because Trading Standard Departments are in each County.
The CEO of your local NHS Trust responsible for what is known as secondary care e.g hospitals and outpatients.
BMA, British Medical Association.
National Media.
In fact there was an article in the Daily Mail this week on this specific issue of patients not being provided with the care that they required from the MSK pathway.
What NHS England is doing is kicking the can down the road because physical health conditions don't improve without help. For instance if a sports person has an injury on the field, his physiotherapy therapist attends to the athlete immediately. They also receive Sports Massage Therapy.
Why is immediate help so necessary? The tissues hold onto memory of the injury. A colleague, a fully qualified Aromatherapist, Teacher of Advanced Massage Therapy recommended that anyone involved in a car accident should see a massage therapist within 48 hours if possible, to get the shock out of the body.
Chiropractors also tell patients that people with back issues have suffered from physical trauma. Injuries from decades earlier can manifest later in life. Our physical bodies are far more fragile than most people think or know.
Handing out pieces of papers with exercises on is not going to relieve the physical trauma. It requires deep and intensive work on tissues, muscles, ligaments, tendons and meridians. Lymphatic drainage is also essential that is accomplished via deep tissue massage. Of course, what a person eats and drinks can also have an impact, nutrition is a vital factor in giving the body what it requires to help it recover from any health condition. Different systems in the body require different nutrients at different ages. However, that is a different subject matter that has been covered a lot on this blog in recent years.
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