Spinal Pathway

Torbay and South Devon NHS Foundation Trust (TSDFT) has refreshed the commissioned 2003 spinal pathway guidance, relaunched on 1 April 2019, replacing all existing processes across the system. The purpose of refreshing the pathway is to standardise spinal service access across Devon STP for services aligned to spinal surgery at the Royal Devon and Exeter Hospital; to adhere to NICE guidance; to establish more affordable spinal and medical imaging models and to support sustainable demand management within these areas.

In practical terms, the introduction of the refreshed spinal pathway means that GPs will no longer have requesting rights for Magnetic Resonance Imaging (MRI) for back pain and will refer into physiotherapy as primary access to secondary Care.

The refreshed pathway functions in a similar way to the MSK hip and knee commissioned pathway, where patients attend a community physiotherapy service and then if appropriate, physiotherapists refer the patient onwards to the spinal ESP service. Spinal ESP colleagues will be the secondary care point of access to orthopaedic and rheumatology services.

Assessment

If a patient presents with a spinal issue, advise the patient to seek and carry out guidance about improving the issue. If there is no improvement in 7 days, advise the patient to book an appointment with the MSK community physiotherapy department by going online at https://my.patientsknowbest.com/registerPatientStart.action?icode=torbay or by calling 0300 456 9987.

The exceptions to this are if the patient presents with a red flag condition. Please see the red flags section of this guidance.

GPs continue to be able to contact secondary care specialities directly. If you require further information, guidance or advice about a patient or the correct pathway for a patient - including if a patient is thought to represent an exception to the normal pathway - please contact colleagues at TSDFT via the SAICO (seeking advice in the ICO) service:

Please see the process flowchart for the full pathway

Red Flags

Exclusions to the refreshed spinal pathway apply. These patients should receive an urgent referral to secondary care, bypassing community assessment:

  • Suspected Cauda Equina syndrome – refer to the emergency department for assessment
  • History of cancer/patient is under Oncology – possible spinal metastasis
  • Patients with recent trauma should be referred to the emergency department e.g. suspected osteoporotic fracture
  • Under 16 year olds

Please see the process flowchart for the full pathway

Investigations

No investigations are required prior to the patient attending the MSK community physiotherapy appointment

Referral

The refreshed pathway functions in a similar way to the MSK hip and knee commissioned pathway, where patients attend a community physiotherapy service and then if appropriate, physiotherapists refer the patient onwards to the spinal ESP service. Spinal ESP colleagues will be the secondary care point of access to orthopaedic and rheumatology services.

Please ask patients presenting with a spinal issue to seek and carry out guidance about improving the issue. If there is no improvement in 7 days, advise the patient to book an appointment with the MSK community physiotherapy department. Please see the red flags section of this guidance for exceptions to the pathway.

Please see the process flowchart for the full pathway

Referral Instructions:

For referral to the MSK community physiotherapy department:

For referral to secondary care due to red flag condition:

e-Referral Service Selection

Specialty: Orthopaedics

Clinic Type: Back Pain

Service: DRSS-South Devon & Torbay-Orthopaedics-Spine- Devon CCG - 15N

or

Referral to the Emergency Department

Supporting Information

Publication date: May 19

 

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