Self-referral to musculoskeletal physiotherapy in the National Health Service (NHS): a mixed methods, four-domain analysis of 1,000 adult new patients initially assessed via telephone versus face-to-face

Abstract

Introduction In some regions, NHS patients are able to self-refer to physiotherapy. Initial assessment and triage of these referrals is via telephone (PhysioDirect) or face-to-face (Physio Access Clinic). There is currently a scarcity of literature comparing both methods in physiotherapy triage. A multi-domain mixed-methods comparison was conducted to evaluate cost, outcomes & satisfaction of both methods. Method Data was collected for telephone and face-to-face self-referrals from October 2021 to February 2022 and analysed to compare patient outcome, patient satisfaction, physiotherapist perception and cost between both delivery methods. Results Outcomes were analysed across 2402 total patient contacts, with face-to-face assessment showing improved outcomes in all areas compared to telephone assessment. Patient satisfaction was greater following face-to-face assessment than telephone. Physiotherapists showed greater satisfaction, greater diagnostic confidence, greater feeling of support and improved learning with a face-to-face approach. Scaled to 150 patients per week face-to-face only was associated with an annual saving of over £40,000 compared to telephone only initial assessment. This is equivalent to 1503 physiotherapist hours and 550 administrative hours. Conclusion Patients self-referring to musculoskeletal physiotherapy via a face-to-face clinic have improved outcomes with greater reported satisfaction. Physiotherapists preferred face-to-face appointments in all facets examined within this study. A significant annual cost saving was evident through face-to-face contact which is especially relevant in the current economic climate of the NHS. Given these notable advantages of face-to-face triage over telephone triage, these findings could inform the planning of future physiotherapy provision.