New referral pathway would improve access to orthopaedic care and support more efficient health system 

Australia’s healthcare system has an opportunity to improve access to orthopaedic care by better using the existing capability of physiotherapists to assess, manage and guide patients through musculoskeletal care pathways. 

The Australian Physiotherapy Association (APA) is calling on governments in their newly released position statement to enable physiotherapists to directly refer patients to orthopaedic surgeons for defined musculoskeletal presentations where established clinical criteria are met. 

Musculoskeletal conditions are among the leading causes of healthcare use and expenditure in Australia, yet many patients face multiple steps before reaching the most appropriate care. Physiotherapists already assess, diagnose and manage these conditions every day, including identifying when patients require further investigation or specialist input. 

APA National President Dr Rik Dawson said modernising referral pathways would help ensure patients receive care from the right healthcare professional at the right time. 

‘Physiotherapists are already making these clinical decisions every day. We assess patients, provide evidence-based conservative care and identify when further investigation or specialist input is needed,’ Dr Dawson said. 

‘Direct referral pathways would recognise this existing capability, complement the role of GPs, streamline access to specialist care and make better use of the highly skilled workforce already supporting Australians with musculoskeletal conditions.’ 

The proposed reform would not create a new scope of practice or change the role of other healthcare professionals. Instead, it would update referral pathways so patients can access specialist assessment when clinically indicated, while maintaining physiotherapy-led conservative management as the first step for most non-urgent musculoskeletal conditions. 

‘Good healthcare pathways are built around patient need, clinical evidence and effective use of the workforce,’ Dr Dawson said. 

‘This reform is about enabling clinicians to work to their existing capability, improving coordination between healthcare professionals and ensuring specialist services are available for patients who need them.’ 

Evidence shows that pathways prioritising early physiotherapy can reduce unnecessary escalation, improve referral quality and lower system costs without compromising patient safety or outcomes. 

Independent economic analysis commissioned by the APA found that direct referral pathways could deliver an estimated $162.7 million per year in combined health system and patient savings, primarily through reducing general practice consultations undertaken solely for referral purposes. 

To support equitable access, the APA recommends expanding Medicare access to physiotherapy-led conservative management, including additional sessions under chronic condition management arrangements. This would allow more patients to receive appropriate non-operative care before specialist referral is considered. 

‘Patients deserve a healthcare system that is easier to navigate and makes the best use of every healthcare professional’s skills,’ Dr Dawson said. 

‘By modernising musculoskeletal referral pathways, we can improve access to care, support better outcomes for patients and ensure Australia’s health system is ready to meet future demand.’