Darlington Integrated Musculoskeletal Service

Positive effects of introducing the single point of access (SPOA) on secondary care and diagnostics activity in Darlington.

The Darlington locality is part of Tees Valley CCG and is made up of 11 member GP practices, covering a total population of c108,000 over a mainly urban area, coterminous with Darlington Borough Council (DBC). Life expectancy is lower than the England average and 20% of children are from low income families.

The waiting time for orthopaedic surgical procedures has traditionally been the longest for any surgical specialty and the direction of travel was to bring services into a community setting and streamline the pathway for patients.

Connect Health was commissioned to deliver the integrated MSK (musculoskeletal) service in April 2017 in order to offer patients a single point of direct access for musculoskeletal needs and physiotherapy support, rather than seeing their GP for their MSK problem.


Challenges in Darlington prior to the new approach

  • There was the potential for all orthopaedic referrals to be sent to secondary care, resulting in long
    waiting lists

Without making a change, waiting lists would continue to increase, with patients being referred to secondary care when potentially the condition could be treated holistically in the community, particularly when multiple investigations were required.

  • Low surgical conversion rate

Previously referrals to secondary care were through GP referral. A large proportion of those referred directly to orthopaedics did not result in a surgical procedure.


The Solution

Directing patients straight to a MSK service rather than via a GP can improve early management and prevent chronicity.

MSK triage services provide a single point of access for local MSK referrals. They provide specialist clinical review of incoming referrals and triage patients to the most appropriate setting for further treatment and/or diagnosis.


Summary Outcomes

(comparing 17/18 to 18/19)

  • The SPOA was introduced by Connect Health within the first year of the contract which resulted in a 30% increase in anticipated patient referrals.
  • 19% reduction in orthopaedic outpatient first attendances.
  • 25% reduction in Trauma and Orthopaedics Ortho Day cases.
  • 15% reduction in outpatient follow up attendances.
  • 13% reduction in secondary care joint injections.
  • 30% increase in Connect Health MSK appointments.
  • Patient’s average quality of life score is +0.21 for year 19/20.
  • 92% of patients would recommend Connect Health to family and friends.



Impact on patients

Terry Fisher, 67 from Darlington, went from being in a coma and unable to walk to being back on the golf course with help from Connect Health and the Healthy Darlington Programme.

Terry’s condition was so severe he was in an induced coma for 11 days. After discharge, following physiotherapy from Connect and gym work he is now almost back to full fitness.

Read Terry’s story here


Retired medical secretary, Barbara, had a niggling back pain flare up, which thankfully was solved with physiotherapy advice, without having to leave her home.

I had a slipped disc many years ago and from time to time my lower back is very painful. The pain meant I couldn’t walk very far, I avoided housework and knew gardening would be difficult.

Due to Covid restrictions, I had a telephone consultation and the physio recommended some tailored exercises which were emailed over along with video links.

After about 10 weeks I can do all the things I couldn’t do before. I’ve even been digging – which is one of my favourite things to do in the garden. I wouldn’t have even attempted that before I spoke to the physio.

Read Barbara’s story here



Working in partnership


This service is excellent and makes a huge contribution to the patient journey. I have been seeing your patient referrals through to various sites and I am glad to inform you they are appropriate for the clinical conditions. Most of the time, their investigations are done to the level, where we can make the decisions straight away and hence don’t lose any more time in making surgical decisions for these cases. The non-surgical management is exhausted before they come and see us as well, so the patients are fairly confident to talk about the surgical treatment and make decisions.

Rajiv Limaye, Consultant Orthopaedic Surgeon, University Hospital of North Tees and Hartlepool


The Darlington MSK service has demonstrated the value of a single point of access triage service to both patient and health economy. Patients can access the right care, in the right place at the right time ensuring that only those that require a secondary care opinion are referred to hospital services.

Nick Livadas, Clinical Lead – Darlington Service, Connect Health


Future plans

Connect Health is working with the PCN and CCG to provide a First Contact Practitioner (FCP) service across Darlington Primary Care Network to offer a fully integrated pathway.

Building on the successful orthopaedics Single Point of Access, the next step will be the development of a SPOA for all rheumatology referrals.

Connect Health has completed patient and public involvement and engagement with NRAS (National Rheumatoid Arthritis Society) and Healthwatch to improve the physical activity levels of the Darlington population.

The Darlington service moved into new hub premises in February 2021, at the Dolphin Centre. Based in the heart of Darlington town centre, all appointments are offered from there, with access to state of the art gym facilities, leisure centre, bistro and soft play area.


Read the full case study

View the Darlington service page