MSK TRIAGE SERVICES IN EAST MIDLANDS REGION: DO THEY SUPPORT THE NATIONAL SUSPECTED CAUDA EQUINA SYNDROME PATHWAY BY GIRFT?

Cauda equina syndrome (CES) is a rare but serious condition that can result in life-changing disability if not promptly recognised and managed. The National Suspected CES Pathway (GIRFT, 2023) recommends that patients presenting with sudden onset bilateral radicular symptoms without CES features, or those with CES symptoms persisting for more than 14 days, should be assessed within a musculoskeletal (MSK) triage service within 14 days. Since the introduction of this pathway, NHS England has sought assurance of its dissemination and implementation; however, there has been no formal evaluation of whether existing MSK triage services are able to meet the recommended timeframe.

This study aimed to evaluate whether waiting times within MSK triage services across the East Midlands align with the National Suspected CES Pathway. A cross-sectional survey design was employed using an MS Forms questionnaire. The survey was collaboratively developed by clinicians in Derbyshire, where it was initially piloted. Feedback from the pilot informed iterative refinements using the Plan–Do–Study–Act (PDSA) approach. The questionnaire explored urgent appointment waiting times and was distributed via email to all identified MSK triage services in the region. Data were collected between May and October 2025 and analysed using descriptive statistics.

Thirty-one responses were received, representing all counties within the East Midlands. Eight MSK triage services were identified; of these, six (75%) met the 14-day target for urgent appointments in line with the national pathway. Two services (25%) reported longer waiting times of 21 and 28 days. Overall, waiting times ranged from 1 to 28 days, indicating considerable variation between services. This variation suggests inequity in access and may have implications for timely assessment, raising potential patient safety concerns for those experiencing longer waits.

Overall, this evaluation indicates that most MSK triage services within primary and community care in the East Midlands are meeting the 14-day target outlined in the National Suspected CES Pathway. These findings suggest generally good adherence to national standards and provide reassurance regarding service provision. Further work is required to reduce variation, improve equity of access, and ensure consistent adherence to national standards.