The “Virtual Clinic” is the hub of the process. This stage is critical for the safe and efficient running of the whole process. The timing and frequency will depend on local needs and resources. In general, once up and running, it should be possible to discuss 30 new referrals in an hour. Pre-Clinic Planning All referrals should be collated. If possible, radiographs should be pre-loaded onto the PACS system to allow rapid loading. Clinical notes (referral letters and emergency department records) should be available electronically (preferable) or in paper format. Virtual Clinic The Virtual Clinic Staff consists of: Consultant orthopaedic surgeon (lead decision maker) Nurse/ESP (Secretarial support) Trainee (useful for trainees to attend clinic to participate in decision making) The referrals are reviewed and outcome determined. The following outcomes are possible: Discharge with advice Review in general (nurse-led) clinic Review in specialty clinic (Hand/wrist, Shoulder/elbow,Foot/ankle, Knee) After Clinic After the clinic, all patients are telephoned and the injury and treatment plan discussed. If this discussion raises any concerns, or at the patient’s request, a face-to-face appointment may also be made. If patients are not contactable (local protocols may vary) the patient is sent a letter (copied to GP) with a copy of a relevant information leaflet.