Creating a Digital Front Door for MSK Services

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Creating a Digital Front Door for MSK Services

How County Durham and Darlington Foundation Trust redesigned access with SystmConnect

County Durham and Darlington Foundation Trust is one of the largest integrated healthcare providers in the North East of England, delivering acute and community services across County Durham and Darlington. Within the Trust, the Musculoskeletal (MSK) Service supports patients with a wide range of musculoskeletal conditions, providing assessment, treatment and specialist management across the region.

Receiving up to 6,800 referrals every month, the service plays a critical role in helping patients access timely care and specialist support. Like many NHS services, increasing demand, workforce pressures and growing waiting lists created a need for a more scalable approach to managing access while maintaining a high-quality patient experience.

Using SystmConnect and SystmOne, the service redesigned its patient pathway to create a digital front door for MSK services, combining self-referral, online consultation, triage, communication, appointment booking, self-management support and clinical decision-making within a single integrated pathway.

Redesigning the pathway

“Digital transformation is about more than introducing technology. By redesigning our pathway around digital triage, self-management and proactive communication, we’ve improved patient access, supported earlier clinical intervention and helped manage demand without increasing workforce capacity.”

Nicola Emery, Professional Lead, Adult Physiotherapy

 The Trust recognised that meaningful improvement would require more than introducing a new digital tool. Instead, the team undertook a wider pathway redesign centred around digital triage, self-management support and proactive patient communication.

Prior to the redesign, patients were referred through traditional routes, with limited opportunities for early digital triage, supported self-management and proactive communication throughout their journey.

The programme initially focused on digital self-referrals, which went live in March 2026, creating a new route into the service for patients. Primary care referrals are scheduled to follow in July 2026, extending the benefits of the redesigned pathway across a broader patient population.

Through SystmConnect, patients can self-refer, submit information about their condition, receive pathway updates and access support through a single digital entry point into the service. Information submitted through SystmConnect flows directly into SystmOne, allowing clinicians to review, triage and manage referrals within their existing workflows without switching systems or re-entering information.

One integrated solution

A key factor in the success of the project was the ability to deliver the pathway through SystmConnect and SystmOne.

Rather than implementing separate products for referrals, communication and workflow management, the Trust was able to deliver the entire pathway using existing SystmConnect and SystmOne capabilities. Together, SystmConnect and SystmOne provide an end-to-end pathway from referral and triage through to communication, decision-making and ongoing pathway management.

The pathway now incorporates:

  • Digital self-referral and online consultations
  • Structured information gathering to support triage
  • Automated patient communications and pathway updates
  • Appointment booking functionality
  • Self-management resources and advice
  • Earlier review by Extended Scope Practitioners (ESPs)
  • Workflow management and reporting within SystmOne

Integrated reporting provides greater visibility of referral volumes, pathway performance and prioritisation, helping teams manage demand more effectively. Service managers also benefit from improved oversight of pathway performance and demand.

Supporting access and earlier intervention

Improving access was a central objective of the programme and aligns closely with NHS priorities around improving access to care, supporting self-management and making best use of clinical capacity.

Through SystmConnect, referrals are reviewed and prioritised using structured information submitted by patients before clinical assessment takes place. Earlier review by ESP clinicians supports faster decision-making, while richer clinical information helps identify patients requiring urgent intervention and ensures patients are directed to the most appropriate care pathway.

The redesigned pathway also supports self-management, proactive communication and earlier access to investigations and onward referrals where appropriate.

Measurable benefits

Key outcomes

  • More than 6,000 referrals processed through SystmConnect
  • Management plans implemented within 48 hours 
  • 16% of referrals managed without requiring a routine appointments
  • For some patients, imaging, specialist review and onward referral initiated within 48 hours of submission

For patients

  • Earlier access to assessment, advice and onward management 
  • Improved communication and visibility throughout the patient pathway 
  • Increased opportunities for supported self-management 
  • Faster access to investigations and onward referrals where required

Patient feedback has highlighted the value of improved communication, digital updates and quicker access to advice and management.

For clinicians

  • Earlier specialist review by ESPs 
  • Better-quality information to support triage and decision-making 
  • Earlier identification of patients requiring urgent intervention

Staff feedback has highlighted reductions in administrative burden and improvements in patient flow.

For the service

  • Reduced administrative workload 
  • Better utilisation of clinical capacity 
  • Improved service efficiency 
  • Additional capacity created through supported self-management

Together, these benefits have helped the service manage growing demand, improve service efficiency and make better use of existing clinical capacity.

More than technology

The team emphasises that successful digital transformation depends on pathway redesign, strong clinical leadership and staff engagement as much as technology itself. Clinical leadership was central to both the design and implementation of the pathway. Maintaining high-quality triage information, ensuring clear communication throughout the pathway and providing alternative access routes for patients who may struggle with digital systems have all been important to the success of the programme.

Building a sustainable model for the future

Introduced as part of a phased digital transformation programme in December 2025, the solution has been operating through a pilot and implementation phase, with self-referrals going live in March 2026 and primary care referrals scheduled to follow in July 2026. The service expects further benefits through increased use of supported self-management, continued improvements in productivity, enhanced patient engagement and further reductions in waiting times.

For County Durham and Darlington Foundation Trust, the initiative demonstrates how digital innovation can improve service efficiency and workforce sustainability while helping services manage growing demand. As NHS organisations seek sustainable ways to improve access and manage demand, the Trust believes the model could support wider transformation across outpatient and allied health professional services.