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What if half the fracture clinic queue never needed to be there at all? We sit down with a veteran hand and upper limb surgeon whose career spans elite sport, complex wrist trauma, and a passion for redesigning care so patients get help faster, safer, and with far less hassle. From the early days of noticing waste in patient pathways to formal lean training inspired by the Virginia Mason method, you’ll hear how small, focused changes add up to a system that actually works for people.
We break down the virtual fracture clinic model that started as a pre‑COVID experiment and scaled during lockdown with Pathpoint. The workflow is simple and powerful: senior triage, proactive phone reviews, and clear, multimedia care plans that let patients recover at home when hands-on assessment isn’t needed. With 134 condition‑specific plans and publicly available instructional videos, the team now safely discharges a large share of referrals before clinic day, opens access for urgent GP cases, and reduces travel, carbon, and waiting-room frustration—gains recognised with national awards.
Then we go inside WALLANT: wide awake, local anaesthesia, no tourniquet. By moving common hand procedures like carpal tunnel release out of main theatres and into outpatient or high‑street settings, costs drop dramatically, outcomes remain equivalent, and patients avoid fasting and half‑day admissions. National guidance now backs this shift, paving the way for broader adoption. Along the way we tackle the hard parts: building clinician buy‑in, training busy consultants, treating triage as a skilled practice, and choosing conservative management when surgery adds no value. We close with a practical vision—expanding accessible, wide‑awake hand care to cut year‑long waits down to weeks.
If thoughtful systems design and humane, efficient care matter to you, this conversation delivers concrete playbooks you can use. Subscribe, share with a colleague who loves improving pathways, and leave a review telling us where your service could go leaner next.

Biography

Mr. Muralidhar Bhat is a Consultant Orthopaedic and Upper Limb Surgeon with over 32 years of medical experience and 15+ years as a UK-based consultant. Based at Surrey and Sussex NHS Trust, he is nationally recognised for his innovation in virtual fracture clinics and his pioneering use of WALANT (Wide Awake Local Anaesthesia No Tourniquet) for hand surgery. Murali blends clinical excellence with systems thinking, having trained across India and the UK and led multiple service redesigns to improve efficiency and patient outcomes. His work spans NHS and private practice, and he is a dedicated educator, researcher, and leader in lean healthcare.

Verified Contact Links:

• NHS Profile
• Spire Healthcare Profile
• Linked In: https://www.linkedin.com/in/murali-bhat-3a7b9425/