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Physiotherapists' call for patient self-referral shot down by RCGP

The RCGP has urged caution against a call from physiotherapists for patients to be given the power to self-refer for their services.

The call, contained in a report from the Chartered Society of Physiotherapy (CSP) published today, claimed that making physiotherapists the first point of contact for many musculoskeletal problems would free up ‘more than 100m GP appointments a year’ in England.

The report highlighted FOI data showing a disparity across the UK, with just 31% of CCGs in England saying patients in their area could refer themselves directly for treatment, compared with 86% of patients in Scotland and 63% in Wales. Meanwhile, in Northern Ireland the first pilot scheme was recently approved.

But the RCGP warned that making self-referrals the standard for physiotherapy treatment could have the unintended consequence of swamping physiotherapy services and putting patients at risk.

Dr Helen Stokes-Lampard, RCGP honourary treasurer, said the work of GPs and physiotherapists should ‘complement each other’ and pointed to problems with a previous self-referral pilot.

She said: ‘[W]e are concerned that this scheme would fall short in meeting patient expectations if implemented without due regard for local needs – and in some cases, compromise patient safety if non-musculoskeletal issues are overlooked.

‘A similar scheme in the Midlands previously offered patients open access to physiotherapy, but it was totally swamped with inappropriate self- referrals and eventually shut down, leaving patients bitterly disappointed and GPs to pick up the pieces.’

But CSP chief executive Professor Karen Middleton said: ‘It makes little sense for patients to see a GP when the physiotherapist they are likely to be referred to could assess and diagnose them in the first instance.

‘Offering that direct access allows for an earlier assessment and ensures patients with the most urgent needs are treated sooner and more effectively. In the current climate, there is simply no clinical or financial case to be made for patients taking up a GP appointment when the help they need is available elsewhere.’

A report from a recent pilot study in Barnsley in England reached a similar conclusion to the CSP report – that self-referral reduced costs for the NHS compared with going via a GP.

Readers' comments (9)

  • Oh for goodness' sake! We're always complaining about how general practice is collapsing under patient demand. Here is a very reasonable suggestion for deflecting GP workload (which works well on my patch) and the RCGP is slagging it off!!

    I'm all for self-referral. We could try dentists next. Podiatry. Counselling. Social workers. Professional form fillers. Let's encourage self-referral, rather than cling to this protectionist notion that everyone has to see their GP first for everything.

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  • The rcgp position is bizarre, completely goes against the ethos of general practice which is to encourage self dependence and get away from backwards paternalistic medicine.
    Reduced costs , less waiting time, more patients treated reduced prescribing costs ,
    Frankly I would love to see all services be self referral including 2 week cancer referrals.. It is tick box medicine anyway and adults are perfectly able to tick their own boxes.

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  • Azeem Majeed

    Allowing people to refer themselves to a physiotherapist is an idea that is worth trying. Like all new interventions, it would need to be piloted and evaluated to see if it was clinically effective and cost-effective, and to identify any unintended negative consequences. With waiting times for routine appointments now 1-2 weeks or more in many practices, offering people an option to see a physiotherapist directly without seeing a GP should be considered.

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  • I'd be happy for self-referrals. Let's see how long it takes for the physios to be calling for the gatekeeper role again.

    As an aside, though, 100m consultations?

    That's nearly 1 in 3 of all GP consults!!! This number is nonsenical!

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  • In my county, physio, OT and podiatry are all available via self referral. Have been for ages. Do get some daft referrals but the referral forms are fairly explanatory and tell patients when to rush to GP. Rare to send pt to GP following self-referral assessment. Pt's like it as it quickens the process. DoH clearly want it - they keep prattling on about pt control etc. Does worry me though that GP autonomy constantly undermined and this drip drip effect toward, I think, loss of GP services like U S

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  • Have self referral here too. Works a treat

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  • We have self referral in Edinburgh and I have yet to be told of an inappropriate referral to physio. I gather that patients have to phone a triage line which filters out silly referrals which actually sounds like a good idea for some of my patients too. Really don't see why a GP who most likely knows less than a physio regarding MSK has to see a patient first in order to tell them to see a physio (this is an assumption that my MSK knowledge is less than physios)

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  • We do this locally. Our physiotherapy provider has trialled it in one area for over a year and we have just rolled it our to another area with plans to expand futher. There is no evidence physio gets swamped.
    Direct access i.e. self referral isn't the same as instant access which we are also hoping to trial as evidence from those pilots seems to suggest up to 20% of same say urgent requests could be dealt with by a physio.
    This is the future - there is no way GPs can continue being the first port of call for all patients. For one thing it devalues my skills. A combination of pharmacists, physios, HCAs, nurse practitioners and probably optoms, third sector guides is needed.

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  • We have been offering self-referral for 7 years which we initially piloted in Saxmundham and now we offer this across all of Suffolk for Musculoskeletal Physiotherapy Outpatients.

    Patients get early advice and exercises. Those accessing via the self-referral have a reduced new to follow up ratio by 0.8 of a follow up appointment.

    Our Friends and Family score in March was 97. We have found this to be an extremely successful service.

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