Management of joint and soft tissue injuries in three general practices: value of on-site physiotherapy.

A prospective study was undertaken to determine the potential benefits in patient management and cost effectiveness of physiotherapists employed by general practitioners compared with direct hospital access and access via consultants. The study involved 401 patients from three rural general practices in south Cheshire and north Staffordshire and took place over six months. On-site physiotherapy in general practice premises resulted in higher referral rates to the physiotherapist compared with the practice using direct hospital access or the practice with access via consultants. Both on site and direct access physiotherapy were associated with fewer prescriptions and lower overall prescribing costs per patient than access to physiotherapy via consultants. There was less time lost from work and normal duties for patients attending the practice with on site physiotherapy compared with those attending the practice which required referral via hospital consultants. Access to physiotherapy via hospital specialists resulted in considerably longer delays than on site physiotherapy and greatly increased the financial costs for the patient. Physiotherapy in general practice premises is a cost effective way of dealing with joint and soft tissue complaints. Direct access to the physiotherapy department within hospitals results in longer delays but provides a satisfactory service. There is little to recommend the utilization of hospital consultants as a means of access to physiotherapy.