STEMS-2
Research type
Research Study
Full title
Patient direct access to NHS musculoskeletal physiotherapy: what is the impact on patients, general practice and physiotherapy services?
IRAS ID
225726
Contact name
Annette Bishop
Contact email
Sponsor organisation
Keele University
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Musculoskeletal (MSK) problems are common and costly and are the leading cause of chronic disability worldwide and account for a sizeable proportion of consultations in general practice. Given the ageing population and the increasing impact of these common painful conditions, the demand for MSK healthcare is set to rise and meeting the demand is a challenge for health services. Patient direct access to physiotherapy is a system of access in which patients are able to refer themselves to an NHS physiotherapist directly ‘without having to see anyone else first, or without being told to refer themselves by a health professional’.
The recent Primary Care Workforce Commission has recommended that the role of allied health professionals in primary care requires more evaluation, specifically ‘to determine whether direct access for some conditions makes cost-effective use of NHS resources’ [Primary Care Workforce Commission 2015]. This study specifically addresses this recommendation by investigating the role of physiotherapists in providing direct access services for patients with MSK conditions.
This project includes three components that investigate the impact of patient direct access to physiotherapy. The three components address key evidence gaps about patient direct access, building on our pilot cluster RCT - The Stems Study REC reference: 13/NW/0053.
Component 1 will investigate the impact of patient direct access on GP MSK workload and explore whether other management actions, suggested to reduce in previous observational studies, such as prescribing of medication, work absence and x-rays and scans, differ in practices with and without patient direct access to physiotherapy.
Component 2 will investigate the cost-effectiveness of providing patient direct access to physiotherapy and will entail a more sophisticated evaluation of the potential costs and benefits of patient direct access than was possible in the pilot RCT.
Component 3 will explore, in-depth, the views and experiences of patients, GPs, physiotherapists and commissioners about patient direct access to physiotherapy using qualitative interviews with patients who were referred by their GP (i.e. who did not self-refer), those who self-referred to physiotherapy and those who were recommended to self-refer by their practice, GPs whose practices have patient direct access to physiotherapy and physiotherapists who deliver care to patients accessing physiotherapy via direct access and Commissioners from CCGs within the North West Coast CRN.
REC name
East Midlands - Leicester South Research Ethics Committee
REC reference
17/EM/0310
Date of REC Opinion
16 Aug 2017
REC opinion
Further Information Favourable Opinion