Rumour has it that our local musculoskeletal service may become open-access. Which seems to be on-trend, because among the subsidised new contract cavalry riding to our rescue are ‘first contact physiotherapists’, which I presume implies patient self-referral.
This sounds great: all those sprains, strains, aches and pains can amuse themselves with our physio rather than mentally spraining, straining, aching and paining us GPs.
So why does the one-access idea give me the heebie-jeebies?
For one thing, any deconstruction and hiving-off of our role is just another nail in the coffin of our ‘generalist’ USP. You could, of course, argue that being a less-stressed zombie GP is better than being an overwhelmed living one. But frankly, I prefer to be professionally alive, even if I do feel half-dead by close of play Monday.
And for another, the success or otherwise of ‘open-access’ is very much dependent on the approach of whatever it is the public is accessing. If first contact physios tell patients with a day or so of back pain, neckache, a sore thumb and so on that they should man up, use common sense and employ some time and NSAID gel, then fine. But if they see all-comers, dispense doses of pseudo-science, can’t live with diagnostic uncertainty and have direct access to investigation, then we are in danger of over-medicalising and ramping up patient expectation.
My worry is that they may lean to the latter approach, because they live in a world where they sometimes feel the need to justify their role by aggrandising the symptoms they see. Rather like pharmacists, in fact – another group coming to our rescue, but one living on a planet where trivia is monetised. And maximising minor self-limiting illness is the very opposite of our approach.
So, ‘First contact physiotherapist’? Nah. ‘Fist contact physiotherapist’, maybe.
Dr Tony Copperfield is a GP in Essex
