"back pain relating to ortho problems"

About: Somerset PCT

(as the patient),

Since moving here 2. 5 years ago, I am aware of the differences between care in the SE & here in South Somerset. With someone suffering with major orthopaedic problems, why do you see a specialist ortho GP prior to seeing a consultant, despite having ortho surgery? To bypass the systemn I had to pay over £100 to be seen privately. Surely if GPs know their patients have serious ortho problems, they should be sent directly to a consultant?

Some of my back problems relate to lifting patients & not being diagnosed early enough, after a fall years ago, resulting in developing oesteopenia.

Since coming here I have spent almost £1000 in private physiotherapy. When referred locally, post a total knee replacement, they were more interested in the way I walked & the exercises, but missing a badly swollen knee requiring 4 hourly pain relief. The moment my private physio massaged my ankle & behind my knee, I never needed any more analgesics. Pain relief? I was refused acupuncture, which I find beneficial, as my symptoms are more than a year old. If I need acupuncture I have to return to Surrey. I wonder whether the doctors giving this advice have ever required pain relief. I guess not.

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Response from Karen Howard-Grenville, PALS, Somerset Partnership NHS Foundation Trust

Hello Clothed 433

Thank you for sharing your experience of Somerset Partnership NHS Foundation Trust, and providing us with the opportunity to respond to the issues that you have raised.

I am able to provide you with the following responses, received from the Carolyn Nation, head of Musculo-skeletal Interface Services and Fiona Robinson, the head of Musculo-skeletal Physiotherapy.

Caroloyn says, In 1999/2000 the Orthopaedic Consultants in Somerset noticed that 70-80% of the patients they saw in their out patient clinics did not require surgical treatment, this resulted in them spending a lot of their time in out patients and limited the time they could spend in the operating theatre. The Consultants therefore worked with GPs and Physiotherapy teams to introduce a system where all patients are assessed by an orthopaedic specialists prior to being referred to a surgeon. This service is called the Orthopaedic Assessment Service in Somerset and the pathway is that GPs should refer all orthopaedic patients to this service for assessment. However if GP is very clear that the patient does require surgery and all appropriate investigations and treatments have been performed the Orthopaedic Assessment Service can pass the referral directly to a surgical team.

The introduction of this pathway has resulted in the orthopaedic consultants being able to spend less time in out patients and more time operating which has improved the efficiency of the pathway and reduced the overall waiting time for patients.

Fiona states, It is noted that your posting details a number of musculoskeletal problems for which you have undergone a number of interventions. With regards to the provision of musculoskeletal physiotherapy within Somerset Partnership NHS Foundation Trust we are currently not commissioned to deliver acupuncture as a stand alone service. Some musculoskeletal physiotherapists may use acupuncture for pain relief to support other physiotherapeutic modalities. If patients are requiring long-term pain management and support, it may be more appropriate that these patients are supported by the Somerset pain management service.

I hope that the above responses have addressed your concerns to your satisfaction, if however, you would like to discuss your concerns further, please contact me, Karen Howard-Grenville, Patient Advice and Liaison Service, (PALS), on 01278 432022 or 432120.

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