Introduction

Specialist Spinal Services provide operative and non-operative management strategies for a variety of conditions ranging from simple pathologies to complex disabling conditions. The existing spinal hub and spoke model implemented in 2015 nationally across the NHS.

We aim to assess the effectiveness and pitfalls of the Spinal hub and spoke model in this questionnaire-based study.

Methods

We conducted a prospective questionnaire-based study in the Northwest England and attendees of the BOA conference in 2021. Questionnaires included from the hospitals with no local spinal services and those with on-site services were excluded. Questions specific to initial assessment, referrals process, MRI availability, and awareness of Spine Hub and Spoke model.

Results

Data collected from 254 orthopaedic surgeons including residents from different regions. Ninety per cent of initial assessments done in the emergency department by doctors without spinal experience. The spinal referral process took between 4–12 hours to receive an opinion. The initial advice given by middle grades of hub following the spinal referrals. 86% of hospitals had no provision to obtain MRI scans out of hours. 90% of orthopaedic surgeons were not confident to convey spine referral outcomes and review them in local clinics. Only 46% surgeons satisfaction with the current model. 78% of middle grades were not aware of the Hub and spoke model.

Conclusions

Our survey identified that orthopaedic surgeons expressed the need for local spinal services for non-urgent cases. Based on this survey we recommend a restructuring of the hub and spoke model across hospitals in the NHS.