Education Session on Referring Patients with Lower Back Pain

Extended Scope Practitioner (ESP) Matthew Carr, who specialises in spinal conditions, was invited by the Meridian Surgery in Peacehaven to give an education session on lower back pain to the GPs and practice nurses. His talk covered the taking of a subjective history, exploration of serious pathologies and making accurate and concise objective assessments. He also touched on psychosocial factors and how behavioural patterns associated with pain can be assessed and managed.

Matthew commented: “Some 30% of GP appointments are for MSK related conditions and of those, around 40%-50% are for back pain. That’s a significant proportion of a GP’s workload, so most doctors and practice nurses have a lot of experience in this area. However, having just 10 minutes to assess a patient can be a challenge – this includes taking a subjective history as well as carrying out an objective assessment – so my aim was to provide some tips and tools for assessing a patient in a short time frame and determining the next steps for making an appropriate referral.”

The group discussed serious pathologies, including referral of suspected Cauda Equina and how to rate the level of concerns of different red flags, which ones – or combinations – need more urgent action.

Matthew also demonstrated a number of physical tests that can be used to quickly assess a patient’s mobility, motor and neurological functions. He said: “These are a more succinct version of some of the assessments that we use in our clinics. However, ESPs have the benefit of 45 minute patient consultations compared with a mere 10 minutes for GPs, so we would carry out a much more involved examination.”

Dr Andy Starling, senior partner at the Meridian Surgery, said: “Matthew led an interactive MSK session on back pain assessment. As MSK lead in our practice I used to feel that I could triage my own referrals and didn’t need this extra level of skill in the pathway. However, it is clear that ESPs, like Matthew, have highly developed diagnostic abilities.

“This, coupled with their physiotherapy treatment skills, makes the ESPs a valuable addition to the team and I would have every confidence in referring through them in the future.”

If you would like an ESP to come and talk to your practice, please contact us on
0300 300 0003 or email