What we got from Sweden … other than Abba

Nottingham’s physios turned to Sweden when bidding for a first contact MSK service.

In 2014 Nottingham City CCG agreed to a one-year valuation of providing physiotherapy, as a first point of contact, for patients with musculoskeletal complaints.
We showed them that patients were reporting ever-increasing waits to see their GP. Also, that with musculoskeletal conditions reportedly making up close to 20 per cent of a general practitioners’ workload, it seemed clear that physiotherapists could play a significant role.
The final piece of leverage was a Swedish publication (Ludvigson and Enthoven, 2012).  It concluded ‘Physiotherapists can be considered primary assessors of patients with musculoskeletal disorders in primary care as few patients needed additional assessment by a GP, patients with confirmed serious pathologies were identified ... and patients were satisfied.’
We subsequently implemented and evaluated a first point of contact physiotherapy service in general practices (Goodwin and Hendrik, 2016, Moffatt, Goodwin and Hendrick, 2018). This reinforced the findings from the Swedish evaluation and went further, demonstrating the significant financial impact of providing physiotherapy as a genuine first point of contact. 
In April 2018, part-funded by a CSP educational travel award and with further support from the  National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, I spent five days in Sweden with the physiotherapy service that had delivered the original first point of contact service in a town called Motala. I also visited the physiotherapy division in the University of Linkopin. 

Both visits provided me with several learning points.

  • They were impressed with the leadership from the CSP on first point of contact physiotherapy
  • Historically, community services in Sweden have been delivered from multidisciplinary medical centres but they had experienced a move towards centralising physiotherapy services into hospitals. This had disrupted multidisciplinary working
  • Nurses at the medical centre screen, triage and signpost patients into the physiotherapy service, often leading to inappropriate referrals
  • General practitioners’ understanding of physiotherapy in Sweden was seen by the physiotherapists as variable. However, initial scepticism at working together had decreased over time. 
There were differences, though, and we parted with a commitment to explore the commonalities and differences.  
  • Rob Godwin, PhD candidate, University of Nottingham School of Medicine


  • Ludvigsson, M.L. and Enthoven, P., 2012. Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Physiotherapy, 98(2), pp.131-137.
  • Goodwin, R.W. and Hendrick, P.A., 2016. Physiotherapy as a first point of contact in general practice: a solution to a growing problem?. Primary health care research & development, 17(5), pp.489-502.
  • Moffatt, F., Goodwin, R. and Hendrick, P., 2018. Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation. Primary health care research & development, 19(2), pp.121-130.
Rob Godwin, PhD candidate, University of Nottingham School of Medicine

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