Managing the Musculoskeletal outpatient demand – Let’s get digital!

Marie Loizides is a Therapy Manager at Barking, Havering and Redbridge University Hospitals Trust and a Digital Pioneer Fellow. In this blog, Marie shares the latest on her project to build and implement a new digital referral tool to the MSK pathway.

With an increasing local population, more people living with long term musculoskeletal (MSK) conditions (conditions that affect our muscles, joints, tendons, bones, nerves) and increasing medical capabilities, how is the NHS going to cope with demand? We need innovative change to improve efficiencies within the system. So let’s get digital and bring the full power of system clinical decision making to the GP to ensure every patient is seen by the right clinician the first time!

My career journey

After working as a systems administrator and programmer for a few years in the early 1990s the call back to education led me to study Physiotherapy at the University of East London. To keep myself in marmite and toilet rolls, I used my free time to subcontract as a programmer, only stopping my computing work to join the NHS as a newly qualified Physiotherapist in 2000.  My clinical experience led me specialise in MSK outpatient physiotherapy. Supportive teams and inspirational patients fuelled my passion to stay with the NHS. Twenty years on as a therapy manager at Barking, Havering and Redbridge University Hospitals Trust my computing skills were re-kindled as I took on the challenge of managing a single point of access service for MSK referrals for our three London Boroughs. We soon realised that to meet the aspirations of the Long Term Plan to increase GP capacity and reduce wait times for elective care we would need to develop our current referral tool. So I applied for the DigitalHealth.London Digital Pioneers Fellowship to support my project to introduce a digitally intelligent referral tool – and so the pioneer journey began!

My Digital Pioneer Fellowship experience

With a mixed programme of structured learning and coaching via action learning sets I soon learned the impact of a two-minute pitch, how to build excitement with strategic influencing, the use of the value proposition and the power of visual data. No problem was too big or small to bring to the action learning sets and this forum inspired me to push boundaries, realise my strengths and value others digital and clinical experience. It was great to be able to work with individuals from different trusts and NHS backgrounds with a common goal to use digital technology to improve care for our patients and wellbeing of our staff. I was empowered to work across organisational boundaries to improve care for patients with MSK conditions feeling confident to engage with partners in our Clinical Commissioning Groups (CCGs), Primary Care, neighbouring trusts and my own trust.

My project

The outcome for our MSK patients is a commitment from our CCG colleagues and clinicians across primary and secondary care to collaborate to invest in and build a digital referral tool that will make clinical decisions at the point of referral to ensure that patients are streamed to the correct service the first time. This will simplify the referral process and free up time for other patient priorities. In fact timings have shown that the new tool could free up GP time to the equivalent of 13,000 appointments per year, reduce waiting lists to Orthopaedics by 30% and ensure patients have the best care we can provide. In a way it will be like having the consultant in the room with the GP, as the questions and answers the tool use are those that have been written jointly between consultants and GPs. 

Looking to the future

I feel very privileged and proud to be part of this improvement journey. With MSK providing a proof of concept, my vision for the future for our health economy is to have all outpatient services (not just MSK) on a digital referral tool. In our area this will have a positive influence for over a quarter of a million referrals. Primary and secondary care will fully collaborate to ensure clinical pathways are continuing to consider the most recent evidence base and are designed to ensure all patients see the right clinician the first time with the best outcomes possible.

DigitalHealth.London is delighted to publish blogs by the NHS staff and digital health companies we support through our programmes, as well as sector thought-leaders, experts and academics. Any opinions expressed within blogs published on our website are those of the author and not necessarily held by DigitalHealth.London. For more information, or if you would like to write a blog for our website, please email