Telephone guidance for musculoskeletal practice

This guidance is designed to support the initial triage decision for clinicians managing a population with musculoskeletal (MSK) conditions in first contact or community care roles. 

We recommend you refer to local guidance for specifics in terms of the further management pathways after an initial triage decision is made.

The guidance below assumes that the patient is in contact with a clinician via telephone and is reporting MSK pain and/or disability.

Clinicians are recommended to:

  1. Firstly exclude red flags/serious pathology as per normal clinical practice and to signpost to appropriate services via the emergency or urgent care pathway which would be the normally embedded local model.
  2. Identify patients who may need a one-off in-person assessment (if the patient is fit and well and it is safe to do so) to support clinical reasoning when unable to clarify if they need to go down the urgent pathway.
  3. Ascertain that the condition presented is not MSK in origin and to signpost to GP.
  4. Ascertain if the condition presented is MSK with no concerning features and then to signpost to relevant advice and exercise resources, or further follow up via telephone as necessary.
  5. Reason whether a routine secondary care referral is required and action as agreed locally. 
  6. Develop a senior support network that offers availability to discuss decisions at any stage and with clinicians in all areas of MSK practice. This needs to be available for contact at all clinical times of service for support and governance.
  7. Where there is no access to Trust phones, personal phones can be used, 141 should be dialled before the patient number and the patient number must be deleted after the call. Reimbursement of personal costs will be considered at local agreement.

If the patient does not respond to the telephone call, follow local agreed action plan.

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