Service
The NHS Lothian integrated shoulder and elbow service is a multidisciplinary collaboration. The service is based on the principles of the right care, from the right person, at the right time in the right place.
- The service offers a single point of access for patients with routine shoulder and elbow problems who require referral for their problem following failure to improve with initial primary care management.
- Once within the service, patients will be able to access all the multidisciplinary services that are required for their problem including physiotherapy, investigation, surgical opinion and pain clinic opinion. There will be no need for patients to return to their GP to seek additional referrals or investigations for their shoulder and elbow problem. The service is underpinned by agreed pathways, escalation criteria and multidisciplinary clinics.
The service has been designed following consultation with; General Practitioner Services, Orthopaedic Services, Physiotherapy Services and Radiology Services.
Who to refer
- All cases of shoulder and elbow problems who have not responded to initial primary care management and do not have the presence of significant red flags
Who not to refer
- Age <16. Refer to paediatric services
- Patients with significant red flags – see referral criteria for further detail in the pathways tool
- Patients who have ongoing problems following surgery, end stage osteoarthritis who have had appropriate conservative management and wish to consider surgical opinion- refer directly to orthopaedics
- For more information NHS Lothian Primary Care Shoulder & Elbow Decision tool
How to refer
- For all cases of shoulder and elbow problems who do not have red flags or the other exclusion criteria refer via SCI Gateway Referral “AHP-Physiotherapy” then choose local site.
- This single referral will gain access to the full multidisciplinary NHS Lothian integrated back shoulder and elbow service. Any consequent investigation/ surgical opinion/ pain service referral will be made within the service- the patient will not require to return to their GP. Please include relevant detail on your referral to allow the appropriate initial triage of the patient.
Interactive pathway link https://www.ckp.scot.nhs.uk//Published/PathwayViewer.aspx?fileId=5404
- Resources inc.
- Integrated Shoulder and Elbow Service PIL v2.pdf
- Link to NHS Inform page shoulder problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/shoulder-problems
- Link to NHS Inform page elbow problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/elbow-problems
- Link to NHS 24 MSK Helpline https://www.nhsinform.scot/care-support-and-rights/nhs-services/helplines/musculoskeletal-msk-helpline
- Link to NHS 24 MSK Help app https://www.nhsinform.scot/care-support-and-rights/tools-and-apps/nhs-24-msk-help-app
- Link to intranet site NHS Lothian integrated shoulder and elbow http://intranet.lothian.scot.nhs.uk/Directory/physiotherapy/NHSLIntegratedShoulderandElbowService/Pages/default.aspx
- Link to new patient facing page for NHS Lothian internet page (to be launched) In draft form currently https://services.nhslothian.scot/ISES
