Patient Direct Access to NHS Musculoskeletal Physiotherapy

Physiotherapist helping a senior man with weights

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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. It is well established in private practice in the UK, as well as in other countries including Australia, the Netherlands and Scotland. Although patient direct access is not a ‘new’ system, it is currently not widely used in the NHS in England. Various future 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.


Arthritis Research UK has 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.

The research component being led by RAND Europe addresses the question as to whether patient direct access to physiotherapy is cost-effective. Other components of the research will analyse the impact of direct access to physiotherapy on GPs’ workload; and will investigate patients’, GPs’, physiotherapists’ and commissioners’ experiences of the direct access pathway.