Optimising Imaging Pathways for Musculoskeletal Presentations in Primary Care: A General Practice Perspective

Background: Musculoskeletal (MSK) conditions account for a substantial proportion of general practice consultations, with low back pain (LBP), knee pain and shoulder pain is the most common. High representation rates emphasise the need for efficient management pathways, including the appropriate use of imaging and referral. First contact physiotherapists (FCPs) have improved patient access to self-management strategies; however, GPs continue to generate the majority of imaging requests. Methods: MSK imaging guidelines for LBP, as recommended by the National Institute for Health and Care Excellence was reviewed. A retrospective 3-month review of LBP presentations was also undertaken in our GP practice, identifying patients coded with ‘LBP’, ‘backache’, ‘chronic LBP’ or ‘lumbago with sciatica’. Results: A total of 299 consultations were recorded (131 male, 168 females; mean age, 63 years). Most patients (66.7%) were initially assessed by a GP, compared with 9% by an FCP, 18% by an advanced nurse practitioner and 6% by an emergency care practitioner. Imaging was requested in 42% of cases: 30% magnetic resonance imaging (MRI) and 12% X-ray. Findings included degenerative disease, suspected discitis, osteoporotic fractures and spondylosis. Referrals to spinal surgery were rare; most patients were managed conservatively with advice, analgesia and physiotherapy. MRI turnaround was 4–5 weeks for routine requests and 8 days for urgent cases. Conclusion: Structured pathways and increased FCP involvement improve the appropriateness of imaging requests and support patient self-management. MRI should be reserved for patients with neurological deficits or suspected serious pathology. Expanding direct physiotherapy access can optimise care and reduce GP workload.