Implementing patient direct access to musculoskeletal physiotherapy in primary care: views of patients, general practitioners, physiotherapists and clinical commissioners in England.
Chinonso N Igwesi-Chidobe, Annette Bishop, Katrina Humphreys and 4 others
PMID 33316866WHAT IT FOUND
Patients found direct access acceptable, but many did not understand it and still needed GP advice.
Poor awareness, confusing forms, lost promotion, poor record sharing, and waiting bottlenecks blocked use.
Key findings
01Patients found direct access acceptable, but most were recommended self-referrers rather than true self-referrers.
02Many patients did not understand physiotherapy’s scope or the direct access pathway, so they relied on GP advice or were unaware they could self-refer.
03Direct access was undermined by poor visibility, confusing forms, weak GP-physiotherapy communication, and an under-staffed central booking system, not by an observed rise in physiotherapy referrals.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was an exploratory qualitative study of views, not a trial of effectiveness or cost. The patient sample was small and came from a limited set of practices in a local region. Patients were mostly women, mostly retired, and mostly White British, so the findings may not cover men, working people, older people with complex needs, or diverse ethnic backgrounds. Health literacy was measured with a brief screening tool that may not capture its complexity. The paper discusses a natural experiment after a pilot trial, so implementation conditions were not controlled like a full RCT.
Declared interests
Funded by Versus Arthritis. An author is an Associate Editor of Physiotherapy.
The easy way to misread this
Do not read acceptability as evidence that direct access works or saves money. This study reports views and implementation barriers, not effectiveness, and cost issues were described as uncertain.