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Wirral University Hospital NHS Foundation Trust

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Wirral Integrated Musculoskeletal Service

There are new changes with regards to Wirral Musculoskeletal (MSK) referrals. 

The Musculoskeletal Integrated Service

From 1st July 2018 Wirral University Teaching Hospital (WUTH) has been the prime provider of MSK services. The service includes physiotherapy, podiatry, elective orthopaedics, rheumatology and pain services.

Referrals are triaged by advanced physiotherapists, podiatrists and specialist rheumatology nurses, who will determine the most appropriate service to treat the patient. The aim is to get the patient to the right service first time, avoid unnecessary appointments and reduce the burden on primary care.

Routine referrals will be triaged within 48 hours (working days) and urgent referrals will be triaged within 24 hours (working days).

The patient will no longer be referred back to the GP to be referred on to another MSK service. The entire patient pathway will be managed by the service, with regular communication back to the GP. The only exception to this is where the Assessment Service has discovered something suspicious. In this case the GP will be asked to re-refer under the 2 week rule. The triaging clinician will call the GP surgery to ensure that this is acted on immediately.

There will no longer be access to book appointments directly to a consultant clinic for MSK specialties, however where appropriate and with adequate information on the referral form, patients will be referred directly from triage to a consultant.

Where the triage decision is to refer to a consultant, the patient will be offered choice of secondary care provider.

Non- MSK physio (Womens, Respiratory, Parkinsons, Neuro) will continue to be referred via WROCS.

If the triage service believes that the patient will benefit from an injection, then there are several options. The patient will be given the earliest appointment in one of these services;

  • GP injection service
  • Patient’s own GP (If GP has indicated on the referral form that an injection is available within 2 weeks)
  • WUTH physio led injection clinic

Urgent Referrals

Urgent referrals will be accepted as urgent if a delay to treatment is likely to result in lasting harm to the patient. Referrals will be changed to routine if this is not the case.

The following should not be referred to the service:

  • Urgent Diabetic Foot Ulcer patients should be referred in the usual way
  • Emergency referrals eg. Suspected Cauda equine should be sent to the Emergency Department
  • Fractures should be referred to the Fracture Clinic
  • 2 week wait referrals should be referred in the usual way

If you are concerned about the symptoms of a patient with a history of cancer, please refer directly to Radiology for an urgent MRI.

How do I refer to the Wirral MSK Service?

Referrals should be sent via the Electronic Referral System (formerly known as Choose & Book) to one of the following services. The services are set up to direct the referral to the most qualified triaging team. 

MSK – Lower Limb Assessment

MSK – Upper Limb Assessment

MSK – Rheumatology Assessment

MSK – Spinal Assessment

MSK – Podiatry Assessment

A MSK referral form must be attached in order for the referral to be submitted. There are two referral forms that can be accessed at the bottom of the screen; MSK and Podiatry (the information required is different for Podiatry).

The referral form can be loaded into EMIS. Forms in EMIS format were emailed to all GP practices in advance of go live. The forms are designed to self-populate with the patient demographics and the last 12 months of bloods and radiology results. If your form does not do this, or is showing more than 12 months, please contact EMIS for advice on how to load the form.

What does the patient need to know?

There is a patient leaflet below that explains the new service to the patient.

Many patients come to the service with expectations of receiving a scan or seeing a consultant which are not clinically indicated. Please support us to manage the patient’s expectations by giving them a copy of the leaflet and explaining that an advanced clinician will choose the most appropriate service for their needs.

The patient may be referred for treatment to an organisation other than Wirral Hospital NHS Foundation Trust e.g. Wirral Community NHS Foundation Trust, Spire Murrayfield, GP Injection Service. Information about the patient will be shared with those organisations for the purpose of healthcare provision.

Joint Replacement Reviews

Referrals for a review post joint replacement should be made to the MSK service. Please specify the length of time post-surgery. The referral will be triaged directly to the Orthopaedic service.

The patient will be invited for x-ray where they will be asked to complete a PROMS form. The image will be reviewed by a doctor who will determine whether a consultation is required.

What information will I receive regarding a patient`s care?



Information sent to GP


Triage outcome via ERS


Letter following all clinic appointments/procedures

MSK Assessment Clinic

Copy of assessment/plan via Docman (in development)

Letters from Advanced Physiotherapists to request changes to medication if necessary



Discharge letter via post

Upcoming developments

GP education sessions will commence in 2019. The GPwSI MSK will visit practices to provide referral support and guidance. Please contact the service if you would like us to visit your practice.

A review of community locations has highlighted a need for more capacity in West Kirby and Birkenhead North. We will be approaching practices in those areas to provide clinic rooms.

We are working with our commissioners to update the Wirral Commissioning Policy in respect of Procedures of Lower Clinical Priority so that second injections and ganglion surgery will be accepted for patients within agreed criteria. Any agreement will be communicated immediately.

  • Wirral Integrated Musculoskeletal Service arrow icon
    • MSK referral form, MSK referral form Modified: 07/09/2018 10:18AM | Download:
    • MSK Useful links, MSK Useful links Modified: 07/09/2018 10:18AM | Download:
    • Podiatry referral form, Podiatry referral form Modified: 22/06/2018 5:27PM | Download:
    • Monthly Newsletters arrow icon
      • GP Monthly Newsletter August 2018 Modified: 17/12/2018 3:08PM | Download:
      • GP monthly newsletter March 2019 Modified: 20/04/2020 9:59AM | Download:
      • GP Monthly Newsletter November 2018 Modified: 20/04/2020 9:59AM | Download:
      • GP Monthly Newsletter September 2018 Modified: 20/04/2020 9:59AM | Download:

Additional Documents

Musculoskeletal Integrated Service Leaflet, Modified: 23/09/2019 9:52AM | Download: Musculoskeletal Integrated Service Leaflet