Call for 'direct physio access'

By Prof Karen Middleton
Chartered Society of Physiotherapy

Image source, Science Photo Library

Accessing a physiotherapist on the NHS usually involves seeing a GP and getting a referral.

But, in this week's Scrubbing Up, Prof Karen Middleton, chief executive of the Chartered Society of Physiotherapy, says it would make much more sense - for both patients and the health service - if patients could have direct access to an NHS physio.

If you ring your local surgery, you can probably get an appointment with the GP or a nurse.

But if you have a common problem such as back or neck pain, should you also be able to see a physiotherapist?

We think so - as do increasing numbers of GPs, who are bringing in physiotherapists to work alongside them in their practices.

These aren't physios the GP refers to - the physio is a patient's first point of contact who they see instead of the GP.

Up to 30% of a GP's caseload can be musculoskeletal (MSK) problems, and physios are the experts in these conditions - so it makes complete sense for them to see those patients.

For patients, the benefits are numerous - it speeds up access to the expertise they need, it reduces the number of appointments they must attend and for some, it even spares them having to undergo surgery later on if a problem is dealt with sooner.

Minor to chronic

At present, the most common route into NHS physiotherapy in England is via a GP referral.

(In Scotland, you can go direct to an NHS physio in all areas, and this is also available to patients in two-thirds of Wales - England lags far behind. It's also the way into private treatment.)

This means waiting for a GP appointment, then waiting for a physio assessment, then, if needed, waiting for a follow-up.

The longer someone waits for treatment, they greater the likelihood is that their relatively minor condition becomes chronic.

So why not see the physio in the first instance?

A physio can assess and diagnose a patient at that first appointment so that their rehabilitation begins immediately.

In many cases, they will just need advice on what to do and the problem will go away.

This then frees up places on the waiting list for people who genuinely need further treatment.

That makes it a better system for patients. But it's a preferable one for GPs as well.

Red flags

Image source, Science Photo Library

Reducing this part of their workload frees them up to concentrate on more serious cases that require a medical diagnosis and with the pressures faced by GPs so well-known, it's understandable why this is an approach that's gaining traction with them.

You'd also need to be living on Mars - or perhaps just outside the UK - to not know of the urgent and enormous problems the NHS faces financially.

The health service has been tasked with finding savings of £22bn by 2020, a vast sum that is placing a huge strain on the ability to continue delivering quality services.

Our modelling shows that if even a fifth of the patients seeing their GP for an MSK problem saw a physio instead, it would save at least £525m a year for the NHS.

That's a conservative estimate, by the way, as it looks only at the savings from that initial appointment.

Additional savings would come from reduced follow-up appointments, fewer tests such as X-rays and scans and lower numbers of referrals on to secondary care in hospitals.

For us, the frustrating thing is that opposition to this approach is often based on two myths.

The first, that patients are not safe being seen by a physio without a doctor assessing them first.

This is complete nonsense - unless you believe that every private patient, every patient in Scotland and those in two-thirds of Wales - where you go direct to a physio -are at risk.

Physios are trained to identify what we call red flags - evidence of serious illness - and would always send those patients on to the most appropriate medical professional.

Research has shown virtually no red flags are missed by physios - so patients can be assured that there is no truth whatsoever in this myth.

Secondly, it's claimed that every Tom, Dick and Harry will flood waiting rooms when they discover how easy it is to get physio.

Again - complete bunkum.

For a start, Tom, Dick and Harry have better things to do than see a physio about a minor twinge they got lifting the shopping out of the car.

This is also backed up by the evidence, which shows no increase in demand over time in services where patients can go direct to the physio.

And actually, overall numbers could drop if patients are seen sooner, and therefore more effectively, so they need fewer appointments.

So it's clear that a solution exists that yields benefits for patients, GPs and the NHS as a whole.

It's right before our eyes - and the important thing now is that it is implemented.

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