Table 5

Associated referral activity for imaged patients

Pre-MRI referralsPeri-MRI referralsPost-MRI referralsFirst to follow-up ratioFirst attendance unit costFollow-up unit costEpisode of care costTotal (costs)Costs (post-MRI referrals only)
Community MSK interface (tier 1 physiotherapy):3135521:3£100.00118 x £100.00 = £11,800.0052 x £100.00 = £5,200.00
Community MSK interface (tier 2 ‘surgical or procedural’):7111311:2£125.00149 × £125.00 = £18,625.00131 x £125.00 = £16,375.00
Community MSK interface
(tier 2 rheumatology):
0121:3£150.003 x £150.00 = £450.002 x £150.00 = £300.00
Secondary care referrals generated by MSK-interface Service:007 × orthopaedic
2 × neurosurgery
1:1.8
1:1.6
£153.00
£198.00
£60.00
£73.00
£261.00
£314.80
(7 x £261.00) + (2 × £314.80) = £2,456.60(7 x £261.00) + (2 × £314.80) = £2,456.60
Secondary care (orthopaedics):00591:1.8£153.00£60.00£261.0059 x £261.00 = £15,399.0059 x £261.00 = £15,399.00
Secondary care (neurosurgery):20301:1.6£198.00£73.00£314.8032 x £314.80 = £10,0720.6030 x £314.80 = £9,444.00
Secondary care
(pain clinic):
0131:2£202.00£72.00£346.004 x £346.00 = £1,348.003 x £346.00 = £1,038.00
Secondary care (neurology):0061:1.6£193.00£97.00£348.206 x £348.20 = £2,089.206 x £348.20 = £2,089.20
Secondary care (rheumatology):1071:3.9£265.00£89.00£612.108 x £612.10 = £4,896.807 x £612.10 = £4,284.70
Secondary care (other):1 × urology
1 × gastroenterology
01 × endocrinology
1 × general surgery
1:2
Total:4148299£67,137.20£56,586.50
Reasons for post-MRI GP
’procedural’ referrals
A wide range of findings underpinned post-MRI procedural opinion referrals. Common themes included: possible nerve root impingement from disc changes, stenosis due to arthropathy, or wedging of vertebrae in spinal imaging; meniscal tears, possible loose bodies, ganglion cysts or changes in anterior or medial collateral ligaments in knee imaging; gluteal medial tendonopathy in hip imaging; and subacromial bursitis or rotator cuff tears in shoulder imaging.
  • Post-MRI ’procedural’ GP referrals for surgical or specialist injection opinions highlighted in yellow.

  • Table 5 ASSUMPTIONS:

  • 1. First to follow-up ratios based on national 2017 hospital attendance data.136

  • 2. Unit costs based on 2017 NHS national tariff costs.49 Secondary care costs are under-estimated as local market-forces-factor variation above national tariff was not included.

  • 3. MSK first to follow-up ratios and episode of care costs, imaging and referral rates based on consensus of published evidence,32 national tariff, published business cases137 138 and local contract data (North West London CCGs 2018).

  • 4. Community MSK-interface service tier 2 ‘surgical or procedural’ referrals included those to extended scope physiotherapist orthopaedics as well as pain services for consideration of spinal injections.

  • 5. Secondary care neurology was a frequent spurious GP referral pathway for suspected radiculopathic symptoms.

  • 6. Non-MSK referrals not included in analysis totals.

  • MSK, musculoskeletal.