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Tagged In:  Physiotherapy

With up to 30% of GP consultations involving musculoskeletal (MSK) problems, self-referral to physiotherapy can cut waiting times and reduce pressure on primary care doctors.




In April 2016 the House of Commons Health Committee extolled the benefits of self-referral to physiotherapy and called for reform to be accelerated. Self-referral first became available in 1978 and many people now have the option. However, availability remains patchy across the UK. The Chartered Society of Physiotherapy (CSP) says that direct access to a physiotherapist is still only available in just over half of CCGs in England. Availability is more widespread in Wales and Scotland, but in Northern Ireland a plan to rollout self-referral services was recently put on hold.

Not just about reducing pressure on GPs


Self-referral to physiotherapists is not just about reducing pressure on overstretched family doctors. A 2014 study in Barnsley carried out by Sheffield Hallam University showed cost savings of over 30% compared with GP-referral, mainly because of reductions in missed appointments, as well as fewer contacts with primary care clinicians. Waiting times were cut to an average of 3.5 days (compared with 31 days for GP referral), while patients reported similar levels of satisfaction with the care they received.

The CSP says that self-referral also helps prevent acute problems from becoming chronic, helps people avoid long-term pain and disability, and reduces sickness absence from work. Additional cost savings are delivered through fewer diagnostic investigations by radiographers and other imaging professionals, as well as lower levels of prescribing.

A more recent study by Keele University supports previous research, indicating that self-referral could offer benefits to patients, GP practices and physiotherapists themselves. Published in March, Stepping up the Evidence of Musculoskeletal Services (STEMS) was the world's first randomised study of direct patient access to physiotherapy.

"The Stems pilot trial showed that introducing direct access into an existing physiotherapy service did not overwhelm the service and no concerns about safety were identified," said Dr Annette Bishop, Keele University's NIHR Research Fellow of MSK Intervention Studies, who led the study.

The CSP estimates that over 100 million GP appointments a year could be freed up by offering direct access to physiotherapists for patients who are suffering back pain and other MSK issues.

"GPs are facing ever-increasing pressure yet out-dated rules mean they are still forced to see and refer patients who should instead be seeing a physiotherapist as the first point of contact," commented CSP Chief Executive Professor Karen Middleton. "It makes no sense to pile that extra workload on GPs, or the cost of an additional, unnecessary appointment onto the NHS."

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