Policy context

Self referral supports current healthcare policy, emphasising choice and control to patients. It encourages autonomous decision making and behaviour, promotes self management and is focussed in primary care.

Self referral does not mean immediate access to physiotherapy, which would create a two tiered system (if the service has a waiting list patients referring themselves would join it in the same way patients who had been referred via a more conventional route). It is simply a way of widening access, adding another option that some patients may prefer.

Self referral is safe. It is also not a new professional privilege. Patients have been referring themselves to physiotherapists in the private sector for nearly 30 years, when the profession introduced autonomy in 1978.

More recently the NHS is realising the benefits of this type of access to both patients and services. Findings published from a National Trial of self referral in 32 sites throughout Scotland found that self referral was cost effective and clinically effective and was popular with physiotherapists, patients and GPs ^[1] . Taking heed of these results, in the white paper Your health, your care, your say (published in January 2006) the government gave a commitment to conduct further evaluations into the effectiveness of self referral to physiotherapy in England.

Currently six pilot sites across England are evaluating the scheme until December 2007. The project will help to add to the evidence about the impact on demand and capacity and to measure the benefits for patients and services. If successful, self-referral could give patients easier, faster access to therapies and ensure a more efficient use of GP's time and resources.

"Being part of a national project has given us an excellent opportunity to share ideas with other physiotherapists working in significantly different hospital and community settings. This shared working has encouraged us to look again at our own processes and procedures and incorporate fresh ideas accordingly. It has also given an ideal opportunity to raise the profile and benefits of physiotherapy within the local area, both to other medical staff and to people living in the community."

Jon Thurlow, Somerset PCT

Self referral has benefits for patients, services and GPs. Research identified that self referring patients presented sooner, achieved better outcomes, were happier with their treatment, and were less likely to take time off work than patients referred by GPs. Physiotherapy services experienced greater efficiency (fewer missed appointments) and improved staff recruitment and retention. Health services were more cost effective, with less GP consultation time, lower rates of prescribing, investigations and secondary referral (refÕs?).

References

1 - Holdsworth LK, Webster VS, McFayden A. What are the costs to NHS Scotland of self referral to physiotherapy? Results of a national trial. Physiotherapy 2007; 93:3-11