Musculoskeletal care runs on terms that mean different things in different services. Triage, first contact, advanced practice, referral optimisation. These pages set out what each one actually means, who does what, and where the decisions are made.
They are written for clinicians working in or alongside these services, for medical and surgical colleagues who were never taught how the front of the pathway works, and for the service leads and commissioners who design and fund it. Every substantive claim is linked to its source. They are written by Dr Arj Imbuldeniya, consultant orthopaedic knee and hip surgeon, and corrected when people who do this work tell us we have it wrong.
Further knee pages are in preparation. They will answer the other questions first contact clinicians ask: whether an MRI is needed before referral, when a suspected meniscal tear needs specialist review, and which findings need urgent escalation.
Each is published only when the clinical content has been reviewed rather than assembled, with the author, the date of review, whether a second clinician has reviewed it, and the evidence behind each statement shown on the page. If you work in first contact MSK and would like to review one before publication, please get in touch.
Orwyn is being co-designed with the clinicians who will use it and with patients, and is designed for NHS Trusts and the services that commission musculoskeletal care.
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