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CAMHS won't see you now

Direct access physio saves us 35 GP slots a month

Dr Tracy Shaw explains how a local scheme has helped to take pressure off her practice

The problem

Whitby Group Practice covers three co-located practices serving approximately 15,000 patients in Ellesmere Port, Cheshire. Our GPs were seeing lots of patients with musculoskeletal problems who ideally needed to see a physiotherapist instead and referring patients to the traditional physiotherapy service normally involved a 12-16 week wait. This wasn’t ideal for patients or a good way to deal with a growing component of GP workload.


What we did

As part of the ‘vanguard initiative’, GPs identified an area where we could improve direct access to physiotherapy in practices, helping to reduce appointments for musculoskeletal problems with the doctors. The Physio First service, run by the local trusts, was the result of this.

The Physio First service is available throughout the West Cheshire area and provides our three practices with 20 physiotherapy appointments every week. The service is provided by two local trusts, which employ the physiotherapists and organise the service, which is then hosted and managed in our practice.

Musculoskeletal patients can be signposted by our trained receptionists to the service and booked directly into the Physio First system without having to see a GP.


Our patients get:

• A single 30-minute appointment with a physiotherapist.

• Skilled assessment and treatment advice.

• A relatively quick appointment, within four weeks.

The service has gained in popularity since we started it and deals mainly with new-onset conditions or exacerbations of more chronic musculoskeletal conditions. Complex or chronic problems can still be referred to our traditional physiotherapy service when longer courses of treatment may be appropriate.



By rearranging delivery of part of an existing service, Physio First has developed a new frontline primary care service, improving access, care and satisfaction for patients. The shorter waiting times, direct access and single therapy sessions mean more patients are able to see a physiotherapist.

We estimate the scheme has freed up around eight GP appointments each week for our practice – which translates to around 35 appointments across a month. This is mainly through patients being booked directly into the Physio First sessions, but also because of a reduction in repeat visits from patients being seen earlier.

Our own referrals into the traditional physiotherapy system have also reduced dramatically, saving us around two hours that we previously spent on writing referral letters and tackling related admin.

Placing therapists in GP surgeries has also helped develop our working relationship. I believe this is what today’s primary care service should be striving to achieve – a multidisciplinary team that our patients can access directly, including physiotherapists, nurses, counsellors, GPs, pharmacists and wellbeing co-ordinators, all working together to cover a range of common presenting problems.

I would definitely recommend having a physiotherapist in your practice if there is budget for it. Like the clinical pharmacist, perhaps the physiotherapist could be a new member of the team, improving access and bringing a new set of skills. If practices directly employed physiotherapists it would allow them to be integrated that little bit more into the primary care team. You could also be more flexible with the system – for example, scheduling shorter appointment times for some problems, introducing some pre-appointment triage and upskilling the wider primary care team through education, which would develop a consistent practice approach to musculoskeletal problems.

Dr Tracy Shaw is a GP at Whitby Group Practice in Ellesmere Port, Cheshire

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Readers' comments (5)

  • Azeem Majeed

    Thank you. A very interesting article.

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  • National Hopeless Service

    Did this 20years ago when fund holding which then got shafted

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  • Yes but the physiotherapist has to be paid for and those GP appointments saved where "free".
    Some manager will just think your going of to play more golf instead, and scrapping the physio first will be a great QIPP saving, or for the STP.
    It's not a new idea but until GPs time is properly priced and paid for you will see your little scheme scrapped like so many before.

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  • You's a great idea if the trusts or CCG are paying for it. But why on earth would a partnership wish to fund work which is already funded elsewhere physio)

    There is a role for a physio in general practice to act like a GP. You know - seeing MSK issues in 10 mins and signposting or referring them. How many do you think will last longer than 3 months doing that?

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  • 35 appointments a week? That is just over 1 day a week of GP clinical time. I assume the physio isn't reviewing blood results and reauths and reading letters? If so you are spending the cost of the physio (+ on costs of about 24%)to achieve less than 1 day of GP activity a week. At best you are cost neutral - at worst I think you are probably spending more to achieve less, unless this is funded in addition to your GMS contract. Why would a partnership want to employ directly though?

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