title: Evaluation of a general practitioner referral service for manual treatment of back and neck pain.
abstract: OBJECTIVE
  To describe and evaluate a community-based musculoskeletal service, commissioned by National Health Services North East Essex Primary Care Trust (PCT), in terms of patient-reported outcomes and satisfaction.
  
  
  BACKGROUND
  Persistent musculoskeletal conditions, including back and neck pain, are costly in terms of primary and secondary healthcare resources. Most patients are assessed and managed by general practitioners (GPs), with referral when necessary to secondary care services.
  
  
  METHODS
  Patients consulting for at least four weeks for back or neck pain were referred by their GP according to patient preference to either a chiropractor or osteopath or physiotherapist working in the independent sector. Patients completed questionnaires at baseline and at discharge from the service.
  
  
  RESULTS
  Questionnaire data were obtained from 696 patients, 97% of whom were seen within two weeks. About half (51%) had had their pain for less than three months, and of the remainder 49% for more than 12 months. Patients received on average six treatments. Using the Bournemouth Questionnaire, the Bothersomeness scale and the Global Improvement Scale, approximately two-thirds (64.6%, 67.8% and 69.9%, respectively) reported improvement at discharge, and approximately 65% a significant reduction in medication. Almost all (99.5%) patients were satisfied with the service. Similarly, almost all (97%) patients were discharged from the service with advice on self-management; the remainder were recommended for secondary care referral.
  
  
  CONCLUSIONS
  This service improved patient access and choice resulting in shorter waiting times and effective outcomes. An impact analysis of the first 12 months of the service by the PCT showed a reduction in primary care consultations and in inappropriate referrals to secondary care.
authors.affiliation: Anglo-European College of Chiropractic, Bournemouth, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Gurden
authors.forename: Marcel
authors.initials: M
authors.lastname: Morelli
authors.forename: Greg
authors.initials: G
authors.lastname: Sharp
authors.forename: Katie
authors.initials: K
authors.lastname: Baker
authors.forename: Nicola
authors.initials: N
authors.lastname: Betts
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bolton
mesh_terms: D001416:Back Pain / Q000534:rehabilitation*; D005260:Female; D058005:General Practitioners; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D019547:Neck Pain / Q000534:rehabilitation*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011320:Primary Health Care; D015397:Program Evaluation; D012017:Referral and Consultation; D057566:Self Report; D013222:State Medicine; D006113:United Kingdom