TAM (Treatments and Medicines) NHS Highland
For MSK physiotherapy: before referring please consider other MSK options.
For early OR less complex cases, please consider:
- NHS Inform MSK resources https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/how-to-access-msk-services
- Highlife Highland exercise programmes https://www.highlifehighland.com/health-and-wellbeing/
- Elemental social prescribing platform Access Elemental - Marketplace
- Digital MSK option: Patients ≥16 registered with a Highland GP can also be offered a digital MSK consultation with a clinically supported, self management rehabilitation option, called PHIO - https://phio.eql.ai/provider/nhsnhighland-gp
How to refer:
- Preferred: SCI Gateway (Physiotherapy to local MSK service)
- Avoid paper referrals, where possible, due to delays.
- Referrals will not be triaged until essential information provided to allow service to decision and plan care
- Frequent referrers: request SCI Gateway access via eHealth SPoC
Essential information required:
- Reason for referral and clinical history.
- Duration, severity, functional impact, sleep, work, pain levels
- Post op details / instructions/ date
- Neurological signs / red flags
- Previous interventions and response
- PMH / DH, investigations
- Pregnancy status
- Work impact
- Veteran status
- If NHS staff member, the impact on their role.
Appropriate referrals (inclusions):
- Age 12+ with MSK condition to 16+ follow Audit Referral pathway and 12 to 16 follow paeds MKS referral pathway and under 12s follow NHS paeds pathway.
- Needs specialist MSK assessment or individualised rehab
- Unresponsive to other MSK Third sector digital / community / primary care options
- Consents and can engage with active rehab
BEFORE referral any investigations such as X-rays, blood tests must have been completed and reported.
Do NOT refer (exclusions):
- Under 12 years
- Uninvestigated red flags or awaiting diagnostics
- For specific standalone interventions e.g injections, ultrasound
- No clear MSK physiotherapy need/problems.
- Careful consideration if person has significant current psychological/complex needs that may impact ability to engage wit active interventions
- Housebound / cannot leave house (refer to community team via SPOA link)
- Careful consideration of creating multiple referrals for the same condition, please discuss with services to ensure best pathway
- Conditions better suited to podiatry / orthotics / other services
Emergency situations (Do NOT refer to MSK physio):
- Suspected Cauda Equina
- Serious neurological deterioration
- Suspected fracture, infection, cancer
- Mental health crisis
Prioritisation:
Urgent criteria (to be seen within 2 weeks):
- <3 months post-op OR post-fracture with functional limitation.
- Pregnancy-related MSK pain.
- NHS Staff with work impact
- <3 months onset meeting the following criteria:
- Progressive neurological deficit/worsening symptoms.
- First episode off work/unable to be carer.
- Severe pain with no relief/major loss of movement.
- Significant sleep disturbance
Routine:
- All other appropriate MSK referrals.
Useful contacts:
- Adult MSK physiotherapy (Inverness & Ross): nhsh.mskphysiotherapy@nhs.scot
- Acute paediatric physiotherapy: nhsh.acutepaedsphysio@nhs.scot
- Community paediatric physiotherapy: Childrens.PTService@highland.gov.uk