Community Orthopaedic Triage and Assessment Service: How physiotherapy-led triage and assessment enables people with musculoskeletal conditions access to appropriate triage, assessment and earlier intervention closer to their home

Ms Sarah Nash1, Ms Catherine Willis1

1Bay Of Plenty District Health Board, Tauranga, New Zealand

With Musculoskeletal (MSK) conditions being the leading cause of disability in New Zealand, the demand on BOPDHB orthopaedics services currently outweighs the capacity to manage this increasing situation. It is essential to provide innovative ways of delivering patient care to meet this need, of which Allied Health services provide many of the solutions.

Internationally, advanced practice physiotherapy roles are well established within physiotherapy-led orthopaedic triage and assessment clinic models. These models have been shown to be safe, cost effective and positively impact waiting times for patients while directing the majority of patients independent of surgical opinion.

The BOPDHB Orthopaedics and Allied Health services have partnered to pilot a Community Orthopaedic Triage Service (COTS). An innovative service model that aims to promote early intervention and provide alternatives to surgery by connecting people at the right time, in the right place with the right person.

COTS provide a comprehensive assessment by a highly skilled physiotherapist who identifies an appropriate wellbeing management pathway, which may include surgical and non-surgical management options. Clinics are located within communities with a particular focus on rural and high Māori population areas.

Outcomes and impact so far:

  • People are seen within a 6-week timeframe
  • 85% of Eastern Bay and 55% of Western Bay general practices can access the service
  • 40% of people assessed are referred for physiotherapy intervention, 31% for orthopaedic specialist opinion, 10% to a combined education and activity programme, 10% are discharged with education and advice.

The COTS model demonstrates:

  • the importance of enabling people with musculoskeletal conditions to have access to appropriate triage, assessment and earlier intervention closer to their home;
  • that experienced MSK physiotherapists are an appropriate alternative for orthopaedic triage and assessment for MSK conditions.


Sarah is a Programme Manager and is a member of the Innovation and Improvement team at the Bay of Plenty District Health Board. She has 7+ years of experience working in health, a background in Public Health and Project/Change management and is the programme lead for the Orthopaedic transformation programme of which the Community Orthopaedic Triage Service (COTS) sits under. Outside of work, Sarah enjoys spending time with her family and friends.

Catherine is an experienced MSK Physiotherapist having completed an MSc in Advanced Practice and worked as an Extended Scope Practitioner in MSK triage and assessment services in UK for close to 2 years before relocating to New Zealand.  Having experience of both ACC and public sector healthcare in New Zealand Catherine, now works as the Clinical Lead Physiotherapist for the Community Orthopaedic Triage and Assessment Service (COTS) in Bay of Plenty.  Catherine is passionate about clinical reasoning and advanced clinical practice.  She currently sits on the working group for the Orthopaedic Physiotherapy Practitioner network in New Zealand.  Outside of work Catherine, enjoys all the sunny Bay of Plenty has to offer.

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