MSK/Diagnostic Uncertainty service

NHS Frimley ICB ("the Commissioner") sought to commission Dr K Lothe and Partners LLP to provide an MSK/Diagnostic Uncertainty service.

MSK/Diagnostic Uncertainty service for Surrey Heath is for patients aged over 18.

The service is a multi-disciplinary community advice, assessment and treatment service to support GPs and community physiotherapists in diagnostic assessment and treatment planning for patients with challenging MSK conditions; i.e. patients where diagnostic uncertainly exists and/or the patient has been unresponsive to previous treatments.

The normal referral route into the service is via a patient's GP. Referrals are also received from Community Physiotherapy providers for diagnostic uncertainty. The initial face-to-face clinical assessment uses a biopsychosocial model, and draws on a multi-disciplinary team of experts. It includes access to biomechanical, pharmacological and psychological assessment.

The aim of the clinical assessment is to identify a diagnosis, where possible, support the referrer and patient in the management of ongoing symptoms where there continues to be diagnostic uncertainty, develop and implement an agreed treatment and/or management plan.

The majority of patients after the initial assessment will be:

• Referred back to the GP with a diagnosis and clear management plan or
• Referred to the community physiotherapy services (Choice of provider to be offered at point of referral) or
• Identified as suitable for the Community Pain Service or
• Referred on to services outside community services.

Treatments are limited to:

• Non-ultrasound guided injections / Ultrasound guided injections
• Advice and signposting to supported self-management and positive lifestyle options, including physical activity and weight management, smoking and diet
• Pharmacological management advice including managing medication and flare-ups.

Follow-up appointments are also provided under this pathway.