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Planned Care Innovation Exemplars

Paediatric Orthopaedic Community Cluster Clinics

Sharon Hortop, Principal Paediatric MSK Physiotherapist
Chris Dobson, Paediatric Orthopaedic Physiotherapist

Cardiff and Vale University Health Board

The demand on secondary care services has increased exponentially during the COVID 19 pandemic. Patients now face long waits to access specialist services.

This includes paediatric orthopaedic planned care clinics; which are an essential service that allow for specialist triage and assessment of children’s musculoskeletal (MSK) and orthopaedic conditions.

Advanced practice physiotherapists are experts in the assessment and management of MSK conditions and their extended assessment and triage skills have been proven to improve patient experience and decrease demand on secondary care services- allowing consultants to see the complex conditions that require surgery or intervention.

The aim of this project is to create physiotherapy led paediatric orthopaedic clinics in GP clusters. Therefore essentially moving a secondary care service into a primary care setting. In addition to providing care closer to home for patients, we will aim to improve the confidence and skills within GP’s with regards to paediatic MSK and orthopaedic knowledge through surveys and targeted teaching sessions.


  • Reduce waits for POS, improve access and experience for patients and families
  • Align new Advanced Physio Practitioner (APP) model with GIRFT and Prudent Principles
  • Reduce unnecessary hospital trips and de-escalate over medicalisation
  • Improve referrals to secondary care through GP training
  • Improve confidence for self-management

The Approach:

  • Established APP Paediatric Orthopaedic Cluster Clinics in 2 GP Cluster practices in CAVUHB
  • Identified GP knowledge gaps/ training needs and delivered training workshops
  • Linked with HEIW to roll out training to new GP trainees

Outcomes / Benefits

  • Secondary care waiting list reduced from 136 weeks to a 77 week wait, 108 patients removed from waiting list
  • 70% of patients seen in 0-2 months
  • 90% of patients did not require orthopaedic input
  • 69% managed and discharged in 1 appointment
  • Just 5% required investigations, referred by APP
  • 100% would recommend services to family
  • 47% increase in GP confidence post training (picture below)

What Next:

  • Embed service locally
  • Expand APP role into fracture clinic
  • Expand training role to GP and paediatrician curriculum through continued link with HEIW
  • Promote wider adoption

View project posters and slides from the PCIP National Showcase Event