3. Musculoskeletal (MSK) Pathway Framework
The Musculoskeletal (MSK) Pathway Framework and the individual components detailed in the document are shown in Figure 1. The term framework is used as each health board will have some necessary variation in musculoskeletal pathways, owing to historical and present service provision as previously described. It is intended, however, that this framework will be the beginning of a process to reduce variation in all musculoskeletal pathways and is not condition-specific. Service users should be involved in the local coproduction and implementation of these pathway standards. Standards A to D are aimed at healthcare professionals (GP, Advanced Practice AHPs or Advanced Practice Nurses) who initially clinically assess the service user. Traditionally, this role was undertaken by GPs, and, for a large number of patients, will continue to be so, however, in contemporary Healthcare delivery this role may be undertaken by a suitably qualified Advanced Practitioner AHP or Advanced Nurse Practitioner with enhanced skills, for example independent prescribing qualifications. Standard E refers to the mode of referral to routine AHP services through GP referral, GP suggested self-referral, self-referral either directly or through a central referral access telephony service, for example NHS 24. Standard F to H detail standards pertaining to a routine AHP musculoskeletal consultation. Standards I, J and K outline the work up of routine patients who require possible escalation or onward referral to secondary care services, for example orthopaedic surgery, neurosurgery, rheumatology or specialist pain management services.
Figure 1: Musculoskeletal (MSK) Pathway Framework - (A Minimum Standard)
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