A cost-benefit analysis of open access to physiotherapy for GPs

Abstract

A pilot scheme for general practitioner open-access to physiotherapy began with the Tormorden practice in June 1985. This pilot scheme was studied by the authors for a thirteen-month period between August 1985 and September 1986 to establish the main cost-benefit implications of providing such a service in this area. The study was designed in consultation with senior officers of the Calderdale Health Authority and involved the Hebden Bridge group practice as a means of comparing a similar practice with a similar population but without an open access facility (control group). Patients in six pre-selected condition groups were chosen as potential beneficiaries of this pilot service and in both practices the progress of these groups of patients were followed irrespective of whether they received physiotherapy via open-access or a consultant referral or not at all (in the case of some control group patients). The main aims of the study were: (i) to assess the impact of open-access on hospital and general practitioner workload and (ii) to quantify the costs and benefits of such a scheme affecting patients, the physiotherapy service and (to a limited extent) on general practitioners. The full conclusions of this study are to be found in Section 6. However, the following are the major findings of this report: 1) The additional (marginal) cost to the physiotherapy department of providing open access for selected patients from one practice was around £3,298 per annum. 2) The service was used responsibly by referring GPs who, in their opinion, found it to be a very useful treatment option. 3) The availability of the open-access service reduced the number of consultant referrals (both urgent and non-urgent), especially those who would have ultimately been seen in the physiotherapy department. 4) The availability of the open-access service generated a demand for physiotherapy services which, under normal circumstances, would have gone unmet and been managed by the patients’ general practitioner. 5) Open-access physiotherapy produced improvements in the patients’ condition (as assessed by both patients and physiotherapists) although no great difference in benefit could be found when compared with physiotherapy obtained by consultant referral (except Group 2) or no physiotherapy at all. 6) Open-access patients used significantly less physiotherapy time and sessions than their consultant counterparts. This reduced the average treatment costs per case from £42 to £25 per case (revenue costs only). 7) The availability of open-access did not reduce the general practitioners’ workload as measured in terms of the number of patient consultations. 8) Open-access patients waited significantly less time to obtain physiotherapy than those patients referred to a consultant. This was reduced from 124 days to 22 days in the study group. This report is a summarised version of a fill report prepared for the Calderdale Health Authority in 1987. Copies of the full report are available from the Authors on request.physiotherapist