Self referral

Self-referral is 'a system of access that allows patients to refer themselves to a physiotherapist directly, without having to see or be prompted by another healthcare practitioner'.⁽¹⁾

There is indisputable evidence that self-referral to physiotherapy results in high levels of service-user satisfaction, lower NHS costs, and lower levels of work absence.⁽²⁾

• Physiotherapists have been able to act as first-contact practitioners since 1978⁽³⁾, but for many years it was common only within private practice. However, self-referral for musculoskeletal physiotherapy has been available in parts of Scotland for some years, and in recent years has been developing in a small, but growing number of areas in the UK. In 2008, the Government set out plans to actively promote the comprehensive roll-out of self-referral to NHS physiotherapy services in England from April 2009.⁽⁴⁾
• Through self-referral, patients can contact NHS physiotherapy services directly, rather than going through their GPs. The patient completes a short self-assessment questionnaire, which is reviewed by a physiotherapist and, depending on their clinical need, and if appropriate, an appointment (which may include a waiting time) is allocated accordingly.
• The approach has a strong evidence base. Pilots in Scotland ⁽¹⁾ and later in England ⁽⁵⁾ found that self-referral has a range of benefits for patients, commissioners, GPs, and employers. It is associated with cost savings, and reduces the need for healthcare interventions such as x-rays and prescribing, and for referrals to orthopaedic specialists. It also lowers rates of sickness absence, and motivates patients to manage their own health.
• Self-referral is popular with patients⁽⁶⁾. It is a patient-centred approach that increases ease of use, convenience, portability, patient influence, choice, engagement and involvement in care, and promotes self-management. The pilots showed that people who self-refer to physiotherapy take fewer days off work and are about half as likely to be off work for one month, compared with those referred to physiotherapy by a GP.⁽⁷⁾
• Self-referral to physiotherapy is efficient for other healthcare providers too, reducing costs, time and resources. Patients often see a GP several times before being referred to physiotherapy, by which time their condition may be more longstanding and difficult to resolve. Evidence shows that early intervention for lower back pain reduces its recurrence in the following year by up to 40 per cent.⁽⁸⁾
• Self-referral has not led to an increase in demand for physiotherapy, apart from in physiotherapy services that have a history of under-referral.⁽⁷⁾ A proportion of people who would normally have seen their GP first simply opt for a more direct route to solve their problem.
• The feedback from GPs in the self-referral pilots (described in the second bullet point, above) was extremely positive, with 91 per cent in the England pilots wanting the self-referral facility to continue.⁽⁹⁾ Reasons for this included savings in GP time (with nearly 24 per cent of patients self-referring) and enhanced patient autonomy, enabling GPs to focus their resources on those with more complex medical problems.⁽⁷⁾