Patient Direct Access to NHS Musculoskeletal Physiotherapy

Physiotherapist helping a senior man with weights

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Meeting the demand for musculoskeletal health care is a challenge for both health services and healthcare providers. RAND Europe assessed the cost-effectiveness of care and the direct access model of care.


Musculoskeletal (MSK) problems are the leading cause of chronic disability worldwide. They are common and costly; in the UK, MSK conditions result in 9.3 million working days lost per year. They also account for at least 14 per cent of consultations in general practice. The most common MSK conditions include osteoarthritis, back pain and knee pain. Given the ageing population and the increasing impact of these common painful conditions, the demand for MSK healthcare is set to rise. Meeting this demand is a challenge for both health services and healthcare providers.

Patient direct access to physiotherapy is a system in which patients are able to refer themselves to an NHS physiotherapist directly rather than going to their GP first. Various models of access to physiotherapists in primary care have been proposed, and direct access to the physiotherapist initiated by a patient is common to all of them.

How did we help?

Arthritis Research UK commissioned a team from Keele University, RAND Europe and the University of Cambridge to investigate the impact on patients, GPs and physiotherapists of patient direct access to NHS physiotherapy in primary care for adults with musculoskeletal conditions.

RAND Europe researchers addressed the question as to whether patient direct access to physiotherapy is cost-effective. Other components of the research analysed the impact of direct access to physiotherapy on GPs’ workload; and investigated patients’, GPs’, physiotherapists’ and commissioners’ experiences of the direct access pathway.

What did we find?

Direct access to physiotherapy services benefits patients and is cost-effective. This is because physiotherapy itself is cost-effective, rather than leading to savings in GP time. Direct access without an increase in supply of physiotherapists would increase waiting times and would be unlikely to be cost saving for the NHS owing to the likely increase in the use of physiotherapy services.