Physiotherapists cut GP orthopaedic referrals by up to 64% in first UK study

Practice-based physiotherapists can significantly reduce GP workload by assessing and managing patients with musculoskeletal (MSK) conditions, research shows.

Physiotherapists could ease GP workload (Photo: Hero Images/Getty Images)
Physiotherapists could ease GP workload (Photo: Hero Images/Getty Images)

MSK conditions account for 30% of GP consultations in England, according to NHS officials - roughly 90m appointments a year.

But the vast majority of patients who typically see a GP for issues such as back pain, osteoarthritis or osteoporosis could be effectively treated by a physiotherapist with ‘minimal GP support’, according to a study published last month in the British Journal of General Practice ().

Researchers evaluated a general practice physiotherapy service in Scotland that launched in 2015, collecting data on ‘outcomes of appointments, GP support, capacity of the service, referral rates to physiotherapy and orthopaedics, numbers of steroid injections and outcomes from orthopaedic referrals.

A total of 8,417 patient contacts were made, and extended scope physiotherapists (ESPs) running the scheme asked for a GP review in only 1% of cases. Just 12% of patients required a prescription and 3% required a fit note, either of which could be issued by the duty GP ‘without the need for an appointment’.

Orthopaedic referrals reduced

Referral rates to orthopaedics dropped significantly across the two GP practices involved in the study, with a 37% reduction in one and a 64% reduction at the other. Overall, 87% of cases were managed within primary care.

‘These results suggest that an ESP can act as a first point of contact practitioner for patients with MSK conditions, independently and effectively, as an alternative to the GP,' the study says. 'Due to current pressures on GP services, ESPs have much to offer in relieving GPs of the MSK component of their caseloads.

‘Within the current climate of significant barriers to GP provision, this will help alleviate some of the pressure.’

The researchers also noted that patients using the ESP service had reported high levels of satisfaction, and that the number of patients given an appointment inappropriately with the ESP was ‘very low’.

‘The patient receives a specialist MSK assessment right at first presentation and GP time is released to focus on patients with other medical problems. The patient sees the right person, in the right place, at the right time,’ the authors concluded.

Physiotherapists in new GP contract

According to NHS England, primary care network funding provided under the new GP contract will allow groups of practices to employ 'an army of 20,000 more staff' - including physiotherapists.

‘By 2024, clinical pharmacists, social prescribing link workers, physician associates, first contact physiotherapists and first contact community paramedics will have become an integral part of the core general practice model throughout England – not just ‘wrap around’ support that could instead be redeployed at the discretion of other organisations,’ the contract reads.

‘70% of the actual ongoing salary costs of additional clinical pharmacists, physician associates, first contact physiotherapists and community paramedics - and 100% of the actual on-going salary costs for social prescribing link workers - will be met, up to the relevant maximum amounts.’

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