Orthopaedic Referrals
Can I Refer to Orthopaedics?
No Direct Referral
All orthopaedic referrals have to go through a tier II service called MCAS / MCATS (Musculoskeletal Assessment and Triage Service).
INFO
What is MCAS?
MCAS sits between primary and secondary care. These clinics are run by specialist physiotherapists who assess one specific joint all the time, and don’t actually offer any physiotherapy themselves.
They can arrange:
- MRI scans
- Referrals to physiotherapy
- Referrals to orthopaedics for injections/surgery
They will often arrange physiotherapy with a view to patients going back to MCAS if symptoms do not improve.
Should I Do an X-Ray/Scan First?
Key Question
Will the scan change your management?
Consider:
- Is there a possible diagnosis that you can manage in primary care without a referral?
- Would you be satisfied with that level of management?
- Tests are most useful to help triage who to send to - whether that be rheumatology/orthopaedics (via MCAS)/physiotherapy
TIP
If there isn’t a clear benefit to arranging a scan, refer to MCAS instead as this will likely avoid delays.
The Patient Saw an Orthopaedic Surgeon Who Said to Ask for a Referral Back
Still Go Through MCAS
Unfortunately we still have to refer to MCAS, but do include that information in the referral as it will help to expedite onward referral by them.
Quick Reference
| Question | Answer |
|---|---|
| Direct orthopaedic referral? | No - must go via MCAS |
| Scan before referral? | Only if it changes management |
| Previous orthopaedic patient? | Still refer via MCAS, include history |