Musculoskeletal problems are one of the biggest things the NHS deals with. 20 million people in the UK live with a musculoskeletal condition. Up to 30% of general practice consultations in England relate to one. The NHS spends around £5 billion a year on them, and around 30.6 million working days are lost to them every year.
ARMA, the alliance of patient charities and professional bodies that speaks for musculoskeletal health in the UK, describes what good care needs: early assessment, rapid advice and appropriate triage, so people get the right support before problems escalate, and strong links between community services and specialist care. Delays, they note, lead to avoidable deterioration, loss of function and increased pressure on the rest of the system.
The GP consultation figure is published by NHS England. The remaining figures and the policy positions are published by ARMA, the Arthritis and Musculoskeletal Alliance. Orwyn has no affiliation with either and is endorsed by neither.
ARMA's analysis of every integrated care board's joint forward plan found that 1 in 3 do not meaningfully reference musculoskeletal health, and 2 in 3 do not reference chronic pain services. Their recommendation is a joined up approach across the whole system, with clear outcomes for the services being bought, and services measured on function and participation rather than on activity.
Orwyn is designed to improve the value of existing MSK pathways, reducing avoidable downstream activity while identifying patients who need specialist review sooner. It is built for one moment inside the spending that already happens: the point where the clinician seeing the patient first decides whether that patient needs a surgical opinion. Get that moment right and the patients who need an operation are found sooner, and the patients who do not are given a clear answer instead of a year of waiting to be told so. Because every decision is recorded with the reason for it, what happens next can be counted. This is the work NHS England calls MSK referral optimisation, and it is judged in both directions rather than on referral volume alone.
Orwyn is for the clinician, in the room, while the patient is in front of them. It is clinician-facing decision support, not a patient questionnaire and not something the patient fills in at home. It fits inside a normal appointment and it does not slow the appointment down.
Every suggestion comes with the reason for it, in plain words. The clinician can disagree and record why, and that disagreement is kept. Orwyn does not check, approve or oversee anyone's work. It carries a surgeon's judgement into a room the surgeon is not in, and the clinician assesses the patient and decides.
General practice still sees most musculoskeletal presentations, in ten minute appointments, alongside everything else. The hardest cases are often the ones already waiting, who keep coming back, where the honest question is whether anything has been missed and whether the plan should change.
Orwyn is designed and tested for first contact musculoskeletal appointments rather than for a ten minute general practice appointment. We are talking to GPs now about whether it is useful in general practice and what would have to change. If you see these patients, we would like to hear from you.
