Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data

Br J Gen Pract. 2019 May;69(682):e314-e320. doi: 10.3399/bjgp19X702245. Epub 2019 Apr 8.


Background: Physiotherapists are currently working in primary care as first contact practitioners (FCP), assessing and managing patients with musculoskeletal conditions instead of GPs. There are no published data on these types of services.

Aim: To evaluate a new service presenting the first 2 years of data.

Design and setting: Analysis of 2 years' data of patient outcomes and a patient experience questionnaire from two GP practices in Forth Valley NHS, UK. The service was launched in November 2015 in response to GP shortages.

Method: Data were collected from every patient contact in the first 2 years. This included outcomes of appointments, GP support, capacity of the service, referral rates to physiotherapy and orthopaedics, numbers of steroid injections, and outcomes from orthopaedic referrals. A patient experience questionnaire was also conducted.

Results: A total of 8417 patient contacts were made, with the majority managed within primary care (n = 7348; 87.3%) and 60.4% (n = 5083) requiring self-management alone. Referrals to orthopaedics were substantially reduced in both practices. Practice A from 1.1 to 0.7 per 1000 patients; practice B from 2.4 to 0.8 per 1000 patients. Of referrals to orthopaedics, 86% were considered 'appropriate'. Extended scope physiotherapists (ESPs) asked for a GP review in 1% of patients.

Conclusion: The results suggest that patients with musculoskeletal conditions may be assessed and managed independently and effectively by physiotherapists instead of GPs. This has the potential to significantly reduce workload for GPs as the service requires minimal GP support. The majority of patients were managed within primary care, with low referral rates and highly appropriate referrals to orthopaedics. Patients reported positive views regarding the service.

Keywords: general practitioner; musculoskeletal diseases; physical therapists; primary health care; referral and consultation.

MeSH terms

  • General Practice* / methods
  • General Practice* / organization & administration
  • Humans
  • Musculoskeletal Diseases* / diagnosis
  • Musculoskeletal Diseases* / therapy
  • Outcome and Process Assessment, Health Care
  • Patient Satisfaction
  • Physical Therapists / standards*
  • Quality of Health Care*
  • Referral and Consultation / organization & administration*
  • United Kingdom