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PURPOSE: Musculoskeletal problems are the leading cause of chronic disability. Most patients in the UK seek initial care from general practitioners (GPs), who are struggling to meet demand. Patient direct access to National Health Service physiotherapy is one possible solution. The purpose of this study was to understand the experiences of patients, GPs, physiotherapists and clinical commissioners on direct access in a region in England with it commissioned. \ud \ud METHODS: The study was informed by Normalisation Process Theory (NTP). Data collection was via semi-structured individual face-to-face and telephone interviews with 22 patients and 20 health care professionals (HCPs). Data were analysed thematically using NPT. \ud \ud RESULTS: Three themes emerged: understanding physiotherapy and the direct access pathway; negotiating the pathway; making the pathway viable. HCPs saw direct access as acceptable. Whilst patients found the concept of direct access, those with complex conditions continued to see their GP as first point of contact. Some GPs and patients reported a lack of clarity around the pathway, reflected in ambiguous paperwork and inconsistent promotion. Operational challenges emerged in cross-disciplinary communication and between HCPs and patients, and lack of adequate resources. \ud \ud CONCLUSION: Direct access to NHS musculoskeletal physiotherapy is acceptable to patients and HCPs. There is need to ensure: effective communication between HCPs and with patients, clarity on the scope of physiotherapy and the direct access pathway, and sufficient resources to meet demand. Patient direct access can free GPs to focus on those patients with more complex health conditions who are most in need of their care.

Background In 2009, the “Don’t forget the children” report recommended that all new HIV-positive patients attending adult HIV services should have any children identified, tested and the information clearly documented. In our clinic, HIV diagnosis in a child was delayed due to lack of a robust testing protocol despite regularly engaging with the mother for her care. We aimed to survey our clinic’s testing practice before and after publication of this report to assess impact. Method A retrospective case note review on all HIV positive women registered at the Solent adult HIV service. The population will be divided into 2 groups: (a) pre guidelines (n = 81), and post guidelines (n = 61). Details of children, their ages, country of residence, testing status, outcomes and timescales were recorded. Results Conclusion Testing of children at risk of HIV has significantly improved in our service since the publication of “Don’t forget the Children”. However this audit identified some children who continue to remain untested or status unconfirmed. We have implemented a robust protocol to chase up outcomes of children tested outside of HIV service and to proactively negotiate testing when parents initially decline consent. Since January 2012, Southampton has been integrated with 3 other clinics to form Solent Sexual Health Service. We plan to extend this retrospective audit to include HIV positive women attending 3 other clinics, which may result in identification and testing of more children at risk.