Self-referral: key to improving access to physiotherapy

The benefits of self-referral make it a win-win for patients, GPs and physios.

Actively promoting self-referral gives key benefits:

  • enables patients to be more autonomous and can result in greater satisfaction from treatment and fewer treatment sessions
  • decreases the GP’s workload and saves money
  • enables you to see patients at a time that suits them resulting in fewer Did Not Attends (DNAs)
  • enables your service to be more responsive and to treat patients that will attend

Self-referral for first appointment


Healthcare systems need to enable patients to make the first appointment themselves. Online self-referral booking should be widely promoted in general practice to GPs, surgery staff and patients.

Encouraging patients to refer themselves, without going to see their GP first can significantly reduce the GP’s workload.

Business cards or leaflets in the surgery and on the GP’s desk with the contact details for the physiotherapy service, are a great way to promote the physiotherapy service directly to patients.

There will always be the need for safeguarding patients who may need support with referral and that should be factored in. Experience demonstrates that the vast majority of patients can and should refer themselves.

Self-referral for follow-up appointments

Self-referral for routine follow-up appointments effectively restructures the choices facing patients. Evidence from the NHS shows that 75 per cent of DNAs are for subsequent and follow up appointments.

Restructuring has been successful in achieving significant changes to the numbers of patients who did not attend appointments. This improves the productivity of therapy services and reduces waiting times for routine appointments.

If the patient feels they need further treatment, they are invited to make their own follow up appointment within a certain period of time following the initial meeting with the physiotherapist. The immediate effects can be:

  • less wasted time for some patients, who might otherwise attend follow-up appointments they do not need
  • reduced numbers of DNAs, because patients choose whether or not to take the initiative in making a follow-up appointment. Those who do, are more likely to keep it.
  • less wasted time for clinicians, because fewer appointment slots are wasted by DNAs. Clinicians are therefore more productive.

Reduced waiting times


Experience of physiotherapy services has shown that waiting times for follow-up appointments are reduced, because appointments are not automatically booked for several weeks ahead.

Reduced waiting times result in patients who choose to book an appointment being offered one soon after they requested it.

Physiotherapists are also more easily able to book in follow-up appointments for more acute patients, who may need hands-on therapy shortly after the first appointment.

By increasing capacity, it also reduces the waiting time for new appointments.

Tips for successfully implementing self-referral  

  • Identify successful examples of implementation of self-referral locally or wider afield if needs be. This will enable colleagues in your team to satisfy any concerns about the clinical value of the change.
  • Develop strong relationships with local key stakeholders and take time to know and understand their needs.
  • Agree protocols: all services should develop protocols in relation to the use of the new system. It should include measures taken to identify those patients who might not be able to make an informed decision about whether to seek a further appointment. Individual physiotherapists should be able to make decisions within the protocol as to whether to use a self-referral route or to book appointments for individual patients.
  • Agree approaches: for physiotherapy services these changes can be challenging to traditional practice. Enabling time and support to engage all involved in this new approach is important to its impact and success.