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.