One million pounds to improve access to physiotherapy

Providing timely access to physiotherapy is a long-standing problem for the NHS, with more than 4 million new referrals each year and waiting times of several months in many areas. A Bristol-led study to improve access has been given £1.06 million by the Medical Research Council (MRC).

The study, led by Professor Chris Salisbury at Bristol University and Dr Nadine Foster at Keele University, will begin in the autumn. Musculoskeletal problems are a major cause of morbidity in the population and a leading cause of days lost from work. They account for 15 per cent of all consultations with GPs and many patients are referred to physiotherapy each year.

While waiting to access therapy, many patients experience pain and disability and may be unable to return to work. As the value of physiotherapy varies for different conditions, some patients experience long waits for treatment which is unlikely to be effective, while others wait for treatment which would have been more effective if delivered earlier.

In an attempt to overcome these problems, several areas have introduced telephone assessment and advice services for physiotherapy, based on computerised algorithms. Following the telephone assessment, patients are sent tailored written advice by post and invited for face-to-face treatment only when necessary. These services are often known as 'PhysioDirect'.

The best known of these services, devised by Jill Gamlin, Consultant Physiotherapist based in the Huntingdonshire locality of Cambridgeshire Community Services, has been commended by NHS bodies and won awards for innovation, but there is a lack of evidence about effectiveness, cost-effectiveness and acceptability to patients.

Professor Salisbury and colleagues will conduct a randomised trial comparing PhysioDirect with usual waiting-list based face to face assessment and care. They aim to test the hypothesis that PhysioDirect will be equally effective and more cost-effective than usual care, while also providing faster access to care and greater patient satisfaction.

PhysioDirect services based on the Huntingdonshire model will be newly established in four Primary Care Trust areas: two in the Bristol and Somerset area and two in the Midlands, each serving at least 25 general practices. The researchers will recruit 1,875 patients in different age-groups and with different conditions, referred by GPs for physiotherapy; they will examine factors associated with the success or failure of the service, the acceptability of PhysioDirect to patients and staff, and ways in which the service could be improved.

Professor Salisbury said: "This trial will provide evidence to support or refute the widespread introduction of PhysioDirect throughout the NHS. If it achieves the benefits in terms of improved effectiveness and efficiency, as well as improved access and satisfaction for patients, which are claimed by early PhysioDirect sites, then the potential advantages for patients and the NHS are considerable."

This trial will provide evidence to support or refute the widespread introduction of PhysioDirect throughout the NHS. If it achieves the benefits in terms of improved effectiveness and efficiency, as well as improved access and satisfaction for patients, which are claimed by early PhysioDirect sites, then the potential advantages for patients and the NHS are considerable.