In person: achieving self-referral to physio in primary care

CSP’s chief exec Karen Middleton reflects on the journey towards achieving self-referral to physio in primary care


Today saw the publication of the Health Select Committee (HSC) report on Primary Care in England and also the publication of the NHS England’s General Practice Forward View. Both are very important documents for primary care in England and for physiotherapy.

Any select committee report is taken very seriously by the government because the recommendations should rise above party politics. They usually deal with an important subject in significant depth with written and oral evidence taken from a range of stakeholders. Providing written evidence is relatively straightforward, but being invited to give oral evidence is what we all aim for.

The CSP started work on this last summer, by preparing written evidence and then developing a plan to receive an invite by the committee. We held a roundtable on primary care at the Conservative Party conference in September and invited key influencers and a member of the HSC. We invited two CSP members, Neil Langridge, a consultant physiotherapist from Hampshire, and Andrew Walton from Connect, to provide frontline examples of what physiotherapy could deliver and how we can be the solution.

The following week we received the invitation to attend the HSC in November. CSP officials hadn’t been before the HSC in 13 years so we needed to make an impact, and the session went well

While waiting for the report to come out on 21 April 2016 we have continued to develop the tools to show the clinical and economic value of physiotherapy in primary care, and we have spoken to key stakeholders about physiotherapy being the first contact practitioner in terms of musculoskeletal (MSK) care. We are now getting third-party endorsement from a range of perspectives, the most recent being Arthritis Research UK.

NHS England has clearly been a major stakeholder and during this period we have been in conversation about fitness for work and support for NHS staff, a passion of Simon Stephens, its CEO. There was then an announcement about access to physio by self-referral for NHS staff.

And today, in perfect timing with the HSC report, NHS England describe the solutions to the demand supply imbalance in primary care being a wider primary care team, including physiotherapists.

All in all, a successful campaign which was well-executed, I’d suggest.

However, I know I will get three questions from members: ‘With the current workforce shortages, how on earth can we do more in primary care?’ ‘Why have you only focused on MSK care?’ and ‘Why such an emphasis on self-referral?’

The answer to the first is that we are unlikely to see any increase in training places unless we demonstrate how we can solve other people’s problems, the one here being primary care. I realise this is difficult, but this is where we have to look at the resource we do have available and make difficult choices, while simultaneously influencing locally those responsible for workforce planning to increase the number of training places – we certainly have enough people wanting to train as physiotherapists!

Secondly, we focus on MSK because this is where the greatest burden of disability lies and because it is easy for commissioners, GPs and the public to grasp, and it is where we have most of our evidence. However, we have started to talk about the management of long term conditions in general and self-referral as a route in too.

And lastly, why is self-referral so important? Well, this is what signifies our autonomy and we know it sends a message about our accountability and responsibility. And, even better than that, we know that a shift to self-referral as an access route means savings to the NHS, fewer prescriptions, better clinical outcomes and a faster return to work - a win-win for patients, clinicians, the system and the tax payer.

Our national influencing has been effective and it is important that carries through to change being seen on the ground. That means working with members to influence locally to deliver new care pathways, deliver a wider primary care team and increase workforce supply is now our mission.

Karen Middleton

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