Clinician-led. Surgeon-supported. Patient-focused.
Better decisions, together.
Orwyn puts a consultant knee surgeon's written judgement into the first-contact consultation: what is most likely going on, what to check, which test to request, what to do today, and when a surgeon is needed. Every answer shows its reasons, and the clinician decides.
Surgery when it's needed. Certainty when it's not.
Most tools built for MSK triage aim to keep people out of hospital. Orwyn helps the clinician decide when a patient should go in, when they should not, and gives the clinician and the patient a reason to trust the answer.
See it
Watch a consultation, start to finish
Read the captions as text
- A first-contact MSK clinician sees a new knee injury.
- A made-up NHS number brings up a test patient. Orwyn will not go on until a side is picked.
- How the injury happened is recorded with a tap.
- The safety questions come first. No result until the clinician has confirmed them.
- History and examination are recorded in taps.
- Each examination test has a short guide to how it is done.
- Orwyn gives the most likely diagnosis, its reasons and what to do today.
- The clinician decides. Agree or change, and the record keeps both.
- Every letter is drafted for the clinician to check.
- The patient gets a page in plain words.
- It is sent by text message or email, or printed to take home.
- Orwyn. Surgical decision support for first-contact MSK clinicians.
Step by step
See Orwyn in a consultation
Four steps from one example patient with a knee injury. No password needed.
Step 1 of 4
The safety questions come first
The clinician confirms the safety questions before anything else appears, and if a rule applies Orwyn names one clear action, where and how quickly.
Step 2 of 4
The most likely diagnosis, with its reasons, and what to do today
The answer comes first, with the findings behind it, two other diagnoses to keep in mind and the actions to take today.
Step 3 of 4
Every letter written
The letter to the patient with a box for the GP, the letters to the surgeon and to physiotherapy, and the request to radiology are written, ready to check, copy or print.
The problem
Musculoskeletal care goes wrong in both directions
First contact clinicians already make this decision every day, and the great majority of those decisions are right. The weak part is the system around them. A patient can be sent for a surgical opinion that was never going to lead to an operation, and wait months to hear it. Another can be managed for a year with a problem that needed surgery sooner. Neither is a failure of the clinician in the room. The specialist thresholds being applied downstream, and what eventually happened to the referral, are not visible at the point the decision is made.
NHS England calls the work of getting this right MSK referral optimisation, and it is not the same as reducing referrals. We explain the terms in plain English: what MSK clinical decision support is, how MSK triage works, and who first contact practitioners are. For service leads and commissioners, we set out how NHS MSK triage works and what services are measured on.
What happens in the consultation
Seven steps, and the clinician decides at every one
Orwyn follows the same steps in every consultation, in the same order, with the safety questions always first. Each answer comes with its reasons in plain words, and the clinician can disagree at any point.
What Orwyn is
A surgeon's criteria, written down and shown
Most patients do not need it. An experienced clinician is certain about most of the people they see, and existing triage stays exactly where it is. Every suggestion Orwyn makes comes with the reason for it, in plain words. There are no scores and no percentages. The clinician can disagree and record why, and that disagreement is kept.
Designed for the clinician
Orwyn is not a patient app and not a questionnaire the patient fills in at home. It is designed to sit with the clinician while the patient is in front of them, and to fit inside a normal appointment. This is clinician-facing decision support rather than patient self-triage, and the difference matters.
It shows its reasons
Orwyn runs on rules a named consultant surgeon has written and signed off, built from national guidance and research evidence. It is not a model whose reasoning cannot be inspected: anyone reviewing a decision can be shown why it was made. What has been tested so far.
With you, not above you
Orwyn does not check, approve or oversee the clinician's work. It carries a surgeon's judgement into a room the surgeon is not in. The clinician assesses the patient and decides.
How Orwyn was built
A collaborative answer to a complex problem
Orwyn was not designed in isolation. It was shaped by detailed conversations with the people who work in and use the musculoskeletal pathway every day: first contact physiotherapists, advanced practice physiotherapists, GPs, orthopaedic surgeons, NHS service managers, commissioners and patients. Each group sees a different part of the same problem, and each has helped shape the answer.
What they described was consistent. Good clinicians are making hard decisions without the information they need, and patients wait too long to find out whether they need a surgeon. Orwyn brings those perspectives together into one shared, written standard that every clinician can see and question.
Written and governed by a named consultant knee surgeon
Orwyn is founded and led by Dr Arj Imbuldeniya, a dual fellowship-trained consultant orthopaedic knee, hip and trauma surgeon with more than 25 years in orthopaedics and musculoskeletal care. For years, physiotherapists and first contact clinicians across West London have picked up the phone or emailed him about a patient, and he has learned as much from those conversations as they have.
Questions
Four questions we are asked first
What is Orwyn?
Orwyn is surgeon-governed decision support for first-contact MSK clinicians. It puts a consultant knee surgeon's written judgement into the first-contact consultation, and the clinician decides.
Who is Orwyn designed for?
The clinician, while the patient is in front of them: first contact practitioners, advanced practice physiotherapists and MSK physiotherapists. Orwyn is not a patient app and not a questionnaire the patient fills in at home.
Is Orwyn artificial intelligence?
No. Orwyn runs on rules a named consultant surgeon has written and signed off, built from national guidance and research evidence. It is not a model whose reasoning cannot be inspected: anyone reviewing a decision can be shown why it was made.
Does Orwyn replace the clinician?
No. Orwyn does not check, approve or oversee the clinician's work. The clinician assesses the patient and makes every decision.
Surgeon-governed decision support for first-contact MSK clinicians.