To improve access to self-management strategies for Musculoskeletal conditions with innovative use of Information Technology in the borough of Bexley. To reduce the burden of MSK pathology on GPs by introducing digital self-referral in the Bexley locality.

Executive Summary

NHS Delivery of Musculoskeletal (MSK) Services poses significant challenges with an ageing population and growing complexity of pathology placing increasing demand on existing community services. In addition, the burden on primary care is great with around 30% of all GP consultations relating to MSK pathology (NHS Long Term Plan, 2019). Considering this, Bexley MSK Service has launched a digital strategy to better manage this demand; by improving access to self-referral and self-management strategies for MSK conditions with innovative use of Information Technology in the borough of Bexley.

The digital initiative has been supported by the Health Innovation Network’s (HINs) digital innovations grant with £10,000 awarded to implement and develop the technology in an NHS MSK Outpatients setting.


Bexley MSK Service is a large Multidisciplinary Team of Physiotherapists, Podiatrists, Hand Therapists and Psychologists offering rehabilitative MSK care to residents in the borough of Bexley. The service ethos is in keeping with GIRFT Project (Getting it Right First time, 2016) and aims to offer a single point of access to patients with MSK conditions, delivering the right care at the right time. The majority (90%) of patients are seen in a community hospital setting by the therapy team and are managed conservatively where possible. The MSK service aims to reduce unnecessary appointments and needless interventions in Secondary Care though seamless pathways do exist where there is a clinical need such as a legitimate surgical target.

The service was originally set up in 2014 and since that time there has been a growing demand for access to the therapies. Bexley MSK service has seen a 17% increase in referral rates in a 5-year period and it is estimated that the rates of referrals will continue to increase year on year, in keeping with national trends. The increase in referral rates is considered in this instance to be a positive reflection on the reduction of referrals into secondary care which is cost-effective and in keeping with NICE guidance for the management of MSK conditions. This does however have implications on how the service can be delivered and a culture of continued service innovation is needed to manage the increased demand.


Engage Consult appears to be an effective means of improving patient activation and access to self-management strategies for patients presenting with painful musculoskeletal conditions. Digital self-referral via an electronic consulting system is a sustainable means of patients accessing MSK outpatients without the need to see their GP and is in keeping with the NHS Long Term plan, and it is estimated that this project may have saved up to 2946 GP appointments over a ten-month period.

Initial review of the revised version of electronic questionnaires developed by Bexley MSK does appear to be safe and effective for screening of MSK pathology in an outpatients setting, and may allow for advice to be given at the point of self-referral. Of note, is the impact of COVID-19 on the project which is delayed against all milestones due to the Pandemic; it’s anticipated that a project of this scale could be achieved faster under normal circumstances and without the pressures of COVID-19.