Direct access to physiotherapy in primary care: now?—and into the future?

Background Patient direct access to physiotherapy (self-referral), is not the routine mechanism in use within the National Health Service (NHS) although more recently it has become a topic of considerable United Kingdom (UK) and international interest.

Aim To develop, implement, investigate and report on a direct access primary care based physiotherapy service.

Design of study Experimental and qualitative.

Setting A general practice in a health district of Scotland.

Method The service was introduced and compared to the existing system of open access over a 12-month period. Demographic and clinical data were collected relating to two samples.

Control year group All general practitioner (GP) referrals in the year prior to the study year.

Study year group general practitioner and direct access referrals. All patients were followed up 1-month after discharge, and the number of associated general practitioner consultations collated together with clinician views of physiotherapy generally and direct access specifically.

Results The control and study year groups were homogenous with regard to number of referrals (339 versus 340), patient age, gender, condition category and its severity. There were, however, significant differences between direct access and general practitioner referrals (22.4%, n=76; versus 77.6%, n=264). Direct access patients were more likely to have been: male, younger, suffering from conditions of a shorter duration, in paid employment with less work absence, more compliant with attendance, had fewer physiotherapy contacts, lower reporting of symptom severity at discharge and were more highly satisfied with their physiotherapy care and experienced less general practitioner consultations (P<0.001). Support for direct access was strongly expressed by service users and clinicians.

Conclusions Direct access to physiotherapy is an example of innovative primary care service provision that is feasible, acceptable to both users and providers and has major implications for general practitioner workload. Its efficacy, however, should be evaluated in a range of settings before being universally introduced.