The usage of direct access MRI for routine MSK conditions has been increasing within City & Hackney and we wanted to highlight the need to ensure patients MSK care in aligned to the agreed, evidenced based, MSK pathways for our patient populations - Please refer to the clinical pathways available on the GP website here.

In the current economic climate, it is important we use funding appropriately in order we can ensure patients are treated quickly and as each MRI cost approx. £140 per scan, we could save over £200k per annum in City and Hackney when compared to the lowest users of MRI in NEL.

As you will be aware, evidence demonstrates that a significant proportion of MRI requests for back pain (75%) and knee pain (76%) in primary care are inappropriate, with only 4.9% of these scans being clinically indicated (Krogh et al., 2022; Khan et al., 2021). Furthermore, studies suggest that even when MRI results show pathology in cases of low back pain, around 90% of individuals with these findings do not experience significant symptoms, demonstrating that the association between such findings and symptoms is weak (Carragee et al., 2006). In addition, disc pathology, such as bulges, protrusions, and annular tears, is common in individuals aged 50 and above and often remains asymptomatic (Brinjikji et al., 2015).

For this reason, the MSK pathways have been developed with all stakeholders and are aligned with national and regional best practice guidelines, with the majority of MSK conditions rarely requiring an MRI from primary care. 

For all routine patients please send for MSK assessment in the community services. For City and Hackney patients (who have not been assessed by an FCP), these should be referred to the Locomotor service via eRS, under Homerton Health NHS Foundation Trust, who will assess and arrange any suitable diagnostics.

Advice and guidance is also available within the Locomotor Service via the ESP team, within eRS.  

Urgent assessments can be referred via email to locomotor@nhs.net. Please see pathways for urgent referral criteria. 

Please refer to the clinical pathways available on the GP website here.

Any queries please contact rcalveley@nhs.net or for clinical queries fiona.wood1@nhs.net