GP case study: Trauma & Orthopaedics

Dr Richard Wright has been a GP for 25 years and currently works at Caterham Valley Medical Practice, in NHS Surrey Heartlands CCG.

“The surgeon’s response was comprehensive and clear, and he set out a management plan for the patient.”

GP case study: Trauma & Orthopaedics

Dr Richard Wright has been a GP for 25 years and currently works at Caterham Valley Medical Practice, in NHS Surrey Heartlands CCG.

In this area Telephone Advice & Guidance is provided by out-of-area NHS consultants on the National Consultant Network. Before Consultant Connect was introduced in East Surrey in April 2020, Dr Wright used to only use the e-RS system to obtain written Advice & Guidance. However, whilst e-RS is still in use for certain types of queries, Dr Wright now sees the benefits of using Consultant Connect as an additional and rapid form of advice:

“It’s quick, easy and responsive.”

When asked what advice he’d give to other GPs he said:

“Try it and see, it’s simple and quick.”

Dr Wright provided the below example of when he used the service to help a patient:

A patient who had been hospitalised with biliary sepsis and during recovery sustained an acute back injury came to see Dr Wright. A CT scan confirmed a bony abnormality in the L2 vertebra, but the MRI scan was deferred as the abnormality was too close to the gallbladder. The patient was discharged with analgesia.

However, upon checking the discharge summary, the normal protocol of no scan for 8 weeks after surgery was waived, due to nature of the presentation. The MRI scan confirmed the acute superior endplate fracture of the L2 vertebra. Dr Wright used Telephone Advice & Guidance via Consultant Connect to get a specialist opinion. He spoke to an out- of-area spinal surgeon from Consultant Connect’s National Consultant Network. Dr Wright explained:

“The surgeon’s response was comprehensive and clear, and he set out a management plan for the patient.”

How Telephone Advice & Guidance helped the patient:

Using Telephone Advice & Guidance in this way meant that the patient was very reassured as Dr Wright had spoken directly to a spinal surgeon, they agreed on the following management plan after advising the patient that acute pain usually diminishes after 3 weeks:

  • DEXA scan needed and add bisphosphonate.
  • Start physiotherapy gently at 6-week mark.
  • No bending or lifting of weights for 3 months post injury.
  • Refer for spinal surgical assessment.

How Telephone Advice & Guidance helped the GP:

Dr Wright was confident that he was providing the best care plan for the patient. Subsequently, Dr Wright also expedited an existing appointment for another patient with the spinal surgery team, citing his discussion with the specialist which helped bring the appointment forward.

Click here to view and download a PDF version of this case study.

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