The Availability of Pre-Referral Imaging for Elective or Thopaedic Referrals at the First Out Patient Appointment

Numerous problems have been highlighted in the pathway directing patients with musculoskeletal pathology from primary to secondary care, such as difficulty in identification of the most appropriate service (eg patients referred to orthopaedics when rheumatology is more appropriate), lack of capacity and high demand for orthopaedics, poor availability of diagnostic imaging and long waits for the first outpatient appointment. The net effect is difficulty in reaching the 18-week 'referral to treatment' target. As a result, many primary care trusts (PCTs) have redesigned their musculoskeletal pathways, commissioning a fully integrated service with the intention of increasing the number of patients being managed in the community, thereby reducing demands on secondary care but, where necessary, supporting the achievement of the 18-week target.