Sheffield spinal pathway audit cycle - pathways, mountains and the view from the top.

There is good evidence to suggest that a proactive stratified approach to management of spinal pain, taking into account psychosocial as well as biological factors, can realise significant savings for health-care systems and perhaps more importantly, health benefits for society at large. This audit cycle report captures data on quality of care and patient flows before and after the mandating of changes to the referral pathways in primary care. These included the introduction of a simple one-sided referral proforma, bounce back of inappropriate referrals from secondary care to physiotherapy lead teams and implementation of the STarT tool, as a decision aid in primary care.