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FOTO Rehab Outcomes Blog

3 Key Factors to Overcome for Successful Direct Access

Direct access is termed self-referral in Europe. The care model of patients seeing a physical therapist first is not new when considering the profession from a global perspective.

In the States there is a growing need for patients with musculoskeletal problems to have fast access to care. Current care models have physical therapists practicing in their own silo in the outpatient setting.  The trend around the globe seems to be multidisciplinary care within primary care practices.

The below abstract focuses on the 3 key factors required for successful implementation of physical therapists in primary care models. A couple of the factors fall right into the lap of physical therapists. We need to prove or know our ability to detect red flags to ensure a patient is provided appropriate care. The other aspect lies in our own perception of our role and how it is different in a primary care setting compared to a private practice.

Below you will find a quick view of the abstract.



Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation.




Primary care faces unprecedented challenges. A move towards a more comprehensive, multi-disciplinary service delivery model has been proposed as a means with which to secure more sustainable services for the future. One seemingly promising response has been the implementation of physiotherapy self-referral schemes, however there is a significant gap in the literature regarding implementation. Aim This evaluation aimed to explore how the professionals and practice staff involved in the delivery of an in-practice physiotherapy self-referral scheme understood the service, with a focus on perceptions of value, barriers and impact. Design and setting A qualitative evaluation was conducted across two UK city centre practices that had elected to participate in a pilot self-referral scheme offering 'physiotherapy-as-a-first-point-of-contact' for patients presenting with a musculoskeletal complaint.


Individual and focus group interviews were conducted amongst participating physiotherapists, administration/reception staff, general practitioners (GPs) and one practice nurse (in their capacity as practice partner). Interview data were collected from a total of 14 individuals. Data were analysed using thematic analysis.


Three key themes were highlighted by this evaluation. First, the imperative of effecting a cultural change - including management of patient expectation with particular reference to the belief that GPs represented the 'legitimate choice', re-visioning contemporary primary care as a genuine team approach, and the physiotherapists' reconceptualisation of their role and practices. Second, the impact of the service on working practice across all stakeholders - specifically re-distribution of work to 'unburden' the GP, and the critical role of administration staff. Finally, beliefs regarding the nature and benefits of physiotherapeutic musculoskeletal expertise - fears regarding physiotherapists' ability to work autonomously or identify 'red flags' were unfounded.


This qualitative evaluation draws on the themes to propose five key lessons which may be significant in predicting the success of implementing physiotherapy self-referral schemes.

 2017 Sep 12:1-10. doi: 10.1017/S1463423617000615. [Epub ahead of print]