You could say that parliament first approved the idea of direct access to physiotherapy in 1977, when it granted clinical autonomy to physiotherapists in the United Kingdom. Since the following year any patients seeking private treatment have been able to refer themselves directly to a physiotherapist.

It's a global concept, too: a 2012 survey found that direct referral for physiotherapy was available in 40 countries, including Australia, Brazil, South Africa, Sweden, and parts of the United States.1

Yet a freedom of information audit conducted by the Chartered Society of Physiotherapy in 2014 showed a strangely inconsistent approach in the NHS.2 In Scotland, 12 of the 14 health boards confirmed that they have full self referral, and the remainder offer it partially, either in selected areas or only for specific conditions. Patients in Wales can access physiotherapy directly in five of seven health board areas. But …