Spinal Neurosurgery

Temporary suspension of Cornwall’s routine spinal surgery service (12th July 2017)


NHS Kernow wrote to GPs in May to update them on the status of the routine spinal service for Cornwall patients and advised it would keep GPs appraised of the situation, which is as follows:


·         Work is underway at NHS Kernow CCG to implement a new spinal pathway for Cornwall patients. This pathway re-design is clinically led and involves input from neurosurgery, pain management, Extended Scope Practitioner Physiotherapists and GPs. It is expected to be in place in September 2017.

·         For reasons outlined below the current pathway carries risk, referrals are not being triaged in a timely manner, patients are often being re-referred to services they have already attended and there is no local acute service provision for patients that do not meet ISTC inclusion criteria.

·         NHS Kernow would therefore like to request that until this new pathway is in place, all GPs consider the state of the current pathway and manage routine patients in primary care and REFER ONLY PATIENTS WITH URGENT SPINAL QUERIES.


The full range of urgent and emergency spinal referrals

• all spinal tumours/suspected spinal tumours
• spinal trauma
• spinal infection
• suspected cauda equina syndrome - these patients should be urgently referred to their local emergency department as currently
• urgent cases with deteriorating neurological status:
• Established or Incomplete Cauda Equina Syndrome
• Myelopathy
• Spinal degenerative pathology with motor deficit
• Spinal pathology with sphincter disturbance
• unremitting pain requiring hospital admission with radiologically demonstrable and surgically remediable pathology

Current service status:


·         Plymouth Hospitals NHS Trust (PHNT)’s routine service: this remains closed. It plans to re-open this in 17-18. There is no confirmed start date at present .

·         PHNT neurosurgery consultant paper triage service for routine referrals: all routine referrals are being sent to this service, which has the capacity to triage the 40-50 referrals per week it receives from RMS and DRSS (some of these are for Devon patients).

·         TemporaryPlymouth Nuffield consultant paper triage service for routine referrals: due to the initial backlog of referrals PHNT received when it opened in May, it has not been able to process new referrals in a timely manner.  To clear the ensuing backlog, NHS Kernow and NEW Devon CCGs have obtained agreement from Plymouth Nuffield that it will assist in triaging this backlog of approximately 120 referrals for Cornwall patients. This started on Monday 10th July 2017 and is expected to take 2-3 weeks. GPs, patients and the referral management services will be notified of the triage outcomes: patient requires routine assessment; patient requires urgent assessment; patient recommended for an alternative service; patient not suitable for spinal surgery. GPs will receive letters to this effect.

·         TemporaryPlymouth Nuffield consultant-led neurosurgery service for non-urgent patients. This will consist of outpatient consultations and treatment where appropriate and in line with Plymouth Nuffield inclusion criteria. This is currently a temporary arrangement whilst conversations continue with PHNT regarding plans to re-open its long-term routine service.


What are the triage outcomes and what will happen to patients already referred?


·         Referrals triaged by PHNT consultants prior to Monday 10th July will either have been rejected as unsuitable for neurosurgery, classified as urgent and accepted into PHNT neurosurgery or classified as routine and offered an outpatient appointment at Plymouth Nuffield. This service will also apply to patients referred between 10th and 16th of July. As of 17th July RMS and DRSS will not be accepting routine neurosurgery referrals and will therefore send only urgent referrals to PHNT.

·         Referral outcomes of Plymouth Nuffield’s temporary consultant paper triage service:

o   routine and accepted by Plymouth Nuffield in accordance with their inclusion criteria

o   routine butunsuitable for Plymouth Nuffield: these will be returned to the patient’s GP. NHS Kernow and NEW Devon are in conversation with acute providers in the South West regarding the provision of a routine service for these patients whilst PHNT’s service remains closed.

o   recommended for an alternative service or unsuitable for spinal surgery: these will be returned to GPs.

·         Patients that then go on to have a routine assessment by a neurosurgeon consultant at Plymouth Nuffield may result in treatment at Plymouth Nuffield, or in an Inter Provider Transfer e.g. for consideration for pain management. N.B. to date these Inter Provider Transfers are in some cases resulting in patients returning to a service they have already attended.



N.B. discussions continue with Ramsay Healthcare UK with regard to potential local service provision.



What will happen from Monday 17th July 2017?


·         GPs should continue to refer urgent neurosurgery query patients in accordance with red flag symptoms. These patients will be referred to PHNT.

·         GPs should manage non-urgent neurosurgery query patients in primary care until the new spinal pathway is implemented (expected date September 2017).

·         From 17th July 2017 the Referral Management Service and DRSS will therefore NOT accept routine neurosurgery referrals until further notice.


Thank you for your co-operation.


If you have any questions or comments please contact Tamsin Jones, Elective Care Programme Manager, NHS Kernow. Tamsin.jones3@nhs.net


Dr. Rob White