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Self-referrals to NHS physios will create ‘small increase’ in MSK appointments

Direct patient access to NHS physiotherapists will increase the demand on general practice, and may fail to reduce GP workload, according to a new study.

Researchers concluded there will be a ‘small increase’ in the number of patients wanting general practice appointments for musculoskeletal conditions, despite them being able to book directly with physiotherapists.

However, the team – from the Universities of Keele, Oxford, Cambridge, Birmingham and East of Anglia and RAND Europe – also concluded that the introduction of self-referrals would be cost-effective for the NHS, because physiotherapists offer good value for money.

It follows research earlier this year that suggested first-contact physiotherapists in general practice could deal wth 99% of patients with musculoskeletal conditions without a GP review, and that 60% of the patients could be self-managed with advice or a brief intervention.

As part of the GP contract in England earlier this year, NHS England committed to providing 70% of the funding for a physiotherapist for every network from 2020.

This latest study – which used a simulation of a hypothetical practice covering 10,000 patients based on pilot cluster randomised controlled trial (RCT) conducted in four general practices in Cheshire – estimated that the number of patients having at least one physiotherapy appointment would increase by 63%.

The study compared the number of MSK patients treated, waiting times, the cost and health benefits among patients referring themselves with the traditional GP-referral system to see whether direct access saves GP time.

At the moment, most patients who require access to physiotherapy on the NHS need to visit their GP or consultant first. 

Under the direct access model, it would cost the NHS £4,999 per quality-adjusted life year (QALY) gained.

The study authors said: ‘The results show the importance of increasing the supply of physiotherapy services to match demand. Direct access coupled with adequate supply of physiotherapy services would benefit patients and be cost-effective.’

Presenting the study this month at the Society for Academic Primary Care conference, Dr Ed Wilson, senior lecturer in health cconomics at the University of East Anglia, and co-author of the study, said: ‘Our results suggest that direct access to physiotherapy is likely to be cost-effective, but this is because physiotherapy itself is generally cost-effective.

‘Crucially, direct access will not reduce NHS costs as any savings will be soaked up by additional physiotherapy activity.’

He later told Pulse: ‘Our data suggested a small increase in the number of patients seeking general practice appointments for MSK conditions despite the introduction of direct access.

‘Self-referral will increase the number of patients trying to make physio appointments. If physiotherapy capacity does not increase then the queues will simply move from the GP’s office to the physiotherapist’s’.

Dr Louise Warburton, a GP with special interest in MSK in Shropshire and a researcher at Keele University, commented: ‘Basically there aren’t enough physiotherapists so it [direct access] would work if there were enough physios to see all the patients coming in. The only reason it’s increasing GP time is because there aren’t enough physios.’

She added: ‘You can self-refer but you have to go to a GP practice and it’s part of the whole GP team. I don’t think it’s been evaluated properly in that setting.’

As part of the new five-year GP contract, released in January by the BMA and NHS England, practices who join a primary care networks will be provided with 70% of the funding required to employ physiotherapists, in a move to bring 22,000 additional practice staff into the workforce.