Musculoskeletal/MSK Intermediate Service (MIS)

The term musculoskeletal (often referred to as MSK for short) covers a wide spectrum of conditions across Orthopaedics and Rheumatology and represents a large proportion of both GP and hospital attendances. 

Staffordshire, along with every other area of the country, have been asked by NHS England to put together a plan as to how we will improve the quality of health and social care tailored around our local population and reduce financial deficits across Staffordshire. These plans are known as ‘Sustainability and Transformation Plans, or ‘STPs’ for short, and they focus on how our local health and social care services will evolve and become sustainable over the next five years in alignment with the NHS Five Year Forward View vision of better health, better patient care and improved NHS efficiency.

As part of the STP the CCGs have implemented an integrated Musculoskeletal Intermediate Service (MIS) for the local population with a musculoskeletal condition (there are over 200 different conditions affecting your joints, bones, muscles and soft tissues, e.g. back pain, neck pain, shoulder, elbow, wrist, knee, ankle or foot problems).  All patients must be referred into MIS before they are referred for further treatment. This ensures that patients are seen in the right place, at the right time by the right health care professional (HCP). Patients will sometimes hear the doctors talk about ‘Red Flag’ symptoms. These are symptoms that may suggest a more serious underlying illness which needs to be diagnosed and treated early and therefore fall outside of this service.

What is MIS?

MIS covers individual services Physiotherapy, Orthopaedics, Rheumatology and Chronic Pain relating to musculoskeletal conditions and provides patients with a one stop access to the wide range of specialties to support the management of their conditions. It is:

  • a joined up approach to providing multi-disciplinary musculoskeletal treatment (including carpal tunnel referrals), chronic pain management (for musculoskeletal patients only), rheumatology nursing care and community physiotherapy through a single point of access.
  • led by Extended Scope Practitioners (ESPs) and has close links to Consultants.
  • supported by new clinical pathways to improve services for patients with musculoskeletal conditions. The pathways were developed by the multi-disciplinary group which comprises of local GPs, Consultant Orthopaedic Surgeons, ESPs and Commissioners which are all based on clinical evidence and best practices.

MSK pathways

pdf The following MSK pathways (626 KB) have been agreed by Cannock Chase, South East Staffordshire & Seisdon Peninsula and Stafford & Surrounds CCGs Membership Boards

Lists of Musculoskeletal procedures are included in the pdf MSK Policy (1.20 MB) ,which sets out the criteria that must be met before the procedure or treatment can be carried out. The MIS Team will use this document to assist in decision making on whether patients can be referred on for treatment.

Useful links

Health & Work - a leaflet about getting you back to health and work

Back pain management - the truth about back pain

NICE evidence for decision aids

There are a number of Arthritis UK leaflets you can download:

Need to know more about this service or gain some clarity on the changes, take a look at this helpful leaflet for patients on MIS.

Tags: msk mis musculoskeletal Orthopaedics Rheumatology Physiotherapy Chronic Pain