ArticleFamily medicine and community health2026
How direct access to physiotherapy reshapes GP gatekeeping for musculoskeletal care in primary care: an exploratory organisational typology across health systems.
Article in Family medicine and community health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo characterise the organisational role configurations of physiotherapists in direct access (DA) models and describe how general practitioner (GP) gatekeeping for musculoskeletal (MSK) conditions is redistributed across health systems.
designSecondary qualitative content analysis of organisational descriptions reported in published DA/first-contact physiotherapy (FCP) studies, using a structured extraction matrix and Enhancing Transparency in Reporting the synthesis of Qualitative research (ENTREQ) reporting standards. Configuration dimensions were informed ex ante by gatekeeping and task-shifting frameworks; configurations themselves were identified inductively. A dimension of operationalised treatment authority was derived during revision from existing extraction-matrix fields.
settingPrimary care settings across high-income health systems, including Beveridge-type (UK, Sweden), Bismarck-type (Netherlands, France) and pluralistic systems (USA), identified through a companion systematic review prospectively registered on the Open Science Framework (osf.io/897ub).
participants19 empirical DA/FCP primary studies were eligible for the source review; 14 contained sufficient organisational detail for configuration mapping.
resultsFour configurations were empirically observed and a fifth was theoretically anticipated but not found. Autonomous first-contact MSK clinician models predominated (12 of 14 studies, predominantly Beveridge-type systems) and differentiated into two subconfigurations on the basis of operationalised treatment authority: front-end assessment and signposting (type 3a, 4 studies, including the National Health Service FCP programme) and full-episode autonomous management (type 3b, 8 studies). Protocol-governed triage with mandatory post hoc medical validation (type 2) and advanced practice with extended scope (type 4) were each observed as illustrative variants supported by a single study. DA redistributed rather than abolished gatekeeping.
conclusionsIn well-documented implementations, DA physiotherapy is most commonly configured as a first-contact model that redistributes GP gatekeeping for MSK conditions. This exploratory typology provides a framework for hypothesis generation and future primary research, particularly in under-represented Bismarck-type health systems.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.