One of the main private medical insurers has just announced they'll be providing nationwide access to physiotherapy through self-referral, rather than requiring any triage from a Doctor or Nurse beforehand.

Whilst Blossoms believes any steps to improve access to care, or to get more value from company healthcare schemes, are noble and should be encouraged, the 'carte blanche' provision of physiotherapy to all is a risky move, for employers and patients.

Referral into care, whichever the therapeutic area, is led by clinicians for good reason, in both the NHS and independent sector.  Clinicians 'gate keep' referrals, ensuring the right care pathway is chosen, based upon informed diagnosis.  The only groups taught the skill of diagnosis are Doctors.

Would a physiotherapist spot the symptoms of malignancies of the spine in a person presenting with general lower back pain, or treat for a few sessions before realising things weren't improving and referring back to a GP?  Would a physiotherapist know the symptoms of rare conditions like spinal tuberculosis, or just begin a course of manipulative therapy?

In addition, a proportion of musculo-skeletal conditions require a referral directly to an Orthopaedic Physician, even one session with a physiotherapist before onward referral could just be adding in additional unnecessary costs in PMI claims.

On balance, although improving access to care should be recognised as a positive step, only trained clinicians are qualified to triage appropriately an suggest the best (and usually most cost-effective) care pathway.